Action Plan to PromoteHealthy Diet Physical Activity · Physical Activity Participation in ......

Action Plan to Promote Healthy Diet and Physical Activity Participation in Hong Kong

Printed by the Government Logistics Department May 2010

Action Plan to Promote Healthy Diet and Physical Activity Participation in Hong Kong

Action Plan to Prom

ote Healthy D

iet and Physical Activity Participation in H

ong Kong

Action Plan to Promote Healthy Diet and

Physical Activity Participation in Hong Kong

Contents

Preface by Professor Alfred CHAN Cheung-ming, Chairman of the

Working Group on Diet and Physical Activity iv

Abbreviations vi

1. Introduction 1

Global situation of non-communicable diseases and

their risk factors 2

Prevalence of non-communicable diseases and their

risk factors in Hong Kong 3

Strategic framework for prevention and control

of non-communicable diseases in Hong Kong 4

Implementation of the strategic framework and

establishment of Working Groups 5

2. Diet, physical activity and health: Hong Kong situation 7

Local situation of dietary habit, physical activity

participation and overweight/obesity 8

Local health promotion activities to promote healthy

lifestyles 13

Analysis 19

iii

3. Actions to promote healthy diet and physical activity

participation 23

Preamble 24

Goals 25

Details of 30 specific actions 25

Table 1 – List of detailed actions with targets and timeframe 45

4. Making it happen 57

Annexes

1. Membership of Working Group on Diet and Physical Activity 60

2. Terms of reference of Working Group on Diet and

Physical Activity 61

3. Discussion topics of Working Group on Diet and

Physical Activity meetings 62

4. Summary of Members’ input on local health promotion

activities 63

5. Health promotion: concepts and practice 69

iiiii

iv

Preface

Globally, we are facing a rising threat imposed by chronic non-communicable

diseases or chronic diseases. Evidence shows that the risk of disease is mainly

attributable to unhealthy lifestyle practices. The World Health Organization

estimated that, worldwide, low fruit and vegetable intake and physical inactivity

account for 2.7 million and 1.9 million deaths respectively. Increasing amounts

of evidence are telling us that the earlier an individual adopts healthy lifestyle

habits, the lower his or her risk of contracting non-communicable diseases during

adulthood and beyond.

Hong Kong is in a process of change. As urbanization and economic growth

are generally welcome, unsatisfactory diet and physical activity patterns have

become more common in our population. People nowadays are more vulnerable

to affluent diets than ever. Besides, many lead sedentary lives. As a result,

increasing numbers of people are becoming overweight or obese. They in turn

experience a higher risk of potentially lethal non-communicable diseases, such as

diabetes mellitus, heart diseases and cancer. If the situation does not improve, the

cost and impact of lifestyle-related diseases on our healthcare system, as well as

society at large, will increase and eventually prove catastrophic.

To avert this from happening, we must work in a coordinated manner and

aim to promote healthy eating and physical activity participation from all sides and

at all levels: the individual, family, organization and the wider community. This

responds to the call made in the Government’s strategic framework document

“Promoting Health in Hong Kong: A Strategic Framework for Prevention

v

and Control of Non-communicable Diseases” published in 2008.

As Chairman of the Working Group on Diet and Physical Activity, I would

like to thank all who helped in drawing up this Action Plan. The objective of

this is to outline the framework of actions that will take place in the coming

few years to support, and help set the direction for, the delivery of effective

health promotion programmes.

This document is a critical step in what must be a broader process to

promote healthy diet and physical activity participation in Hong Kong. It is

a product of collaboration among stakeholders from different sectors of our

society. Every individual and organization has a role to play. The actions

set out here represent a start, not an end. With dedication, partnership,

and coordinated effort called for in this Action Plan, we are better placed to

empower individuals to take responsibility for their health as well as that of

others, and to create a caring community that opens up a wider range of

healthy choices for all. One will agree that, eventually, wellbeing and quality

of life are choices that individuals and communities have to make. Make that

choice today by playing your part in the Action Plan!

Professor Alfred CM CHAN, BBS, JP

Chairman

Working Group on Diet and Physical Activity

vi

Abbreviations

Abbreviations Full name

BRFS Behavioural Risk Factor SurveyCHEU Central Health Education UnitCSC Community Sports CommitteeCUHK Chinese University of Hong KongDH Department of HealthEDB Education BureauEHS Elderly Health ServiceEMACs Estate Management Advisory CommitteesFEHD Food and Environmental Hygiene DepartmentFHB Food and Health BureauFHS Family Health ServiceHA Hospital AuthorityHAD Home Affairs DepartmentHBM Health Belief ModelHD Housing DepartmentLCSD Leisure and Cultural Services DepartmentMCHCs Maternal and Child Health CentresNCD Non-communicable diseasesNCDD Non-communicable Disease DivisionNGOs Non-governmental organizationsPHS Population Health Survey PRH Public rental housingSC Steering Committee on Prevention and Control of

Non-communicable Diseases SCT Social Cognitive Theory SHS Student Health ServiceSTEPS STEPwise approach to SurveillanceSWD Social Welfare DepartmentTDS Total Diet Study

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Full name

Behavioural Risk Factor SurveyCentral Health Education UnitCommunity Sports CommitteeChinese University of Hong KongDepartment of HealthEducation BureauElderly Health ServiceEstate Management Advisory CommitteesFood and Environmental Hygiene DepartmentFood and Health BureauFamily Health ServiceHospital AuthorityHome Affairs DepartmentHealth Belief ModelHousing DepartmentLeisure and Cultural Services DepartmentMaternal and Child Health CentresNon-communicable diseasesNon-communicable Disease DivisionNon-governmental organizationsPopulation Health Survey Public rental housingSteering Committee on Prevention and Control of Non-communicable Diseases Social Cognitive Theory Student Health ServiceSTEPwise approach to SurveillanceSocial Welfare DepartmentTotal Diet Study

Abbreviations Full name

VHTs Visiting Health TeamsWG Working GroupWGDPA Working Group on Diet and Physical ActivityWGPC Working Group on Primary CareWHO World Health Organization Y-HBSS Youth-Health Behaviour Surveillance System

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1. Introduction

Introduction1

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1Global situation of non-communicable diseases and their risk factors

1.1 Withgrowingaffluence,theworld’spopulation is living longer intermsof lifeexpectanciesingeneral.Atthesametime,thereisanincreasingnumberofpeoplesuffering fromnon-communicablediseases(NCD),suchascancer,strokeand ischaemicheartdiseases,whichcause ill-health,disabilityandprematuredeaths. TheWorldHealthOrganization(WHO)estimatedthatofthe58milliondeathsin2005,approximately35million(60.3%)werecausedbyNCD.

1.2 NCDareclosely related to the lifestylepractices,andmanyNCDsharecommonbehavioural risk factorssuchasunhealthydiet,physical inactivityandbeingoverweight/obese.Thepresenceofthesebehaviouralriskfactorscan lead to thedevelopmentofbiomedical risk factors,notablyexcessivebodyweight,highbloodpressure,adversebloodsugarand lipid levels thatare thekeyrisk factors formostNCD. TheWHOestimatedthatbyhavinghealthylifestylesincludinghealthierdiet,increasingphysicalactivityandstopsmoking,atleast80%ofheartdiseasesandtype2diabetesaswellasone-thirdofcancerscanbeprevented. Therefore, to improve thecommunity’shealthprofilethroughpreventionofNCD,highpriorityshouldbegiventothoseinterventions that tackleunhealthydiet,physical inactivity,overweightandobesity,andsmoking.

1.3 Recognising that the rapid riseofNCDwould representoneof themajorhealthchallenges in thecomingcentury, theWHOdeveloped theGlobal Strategy for the Prevention and Control of NCDin2000,theWHO Framework Convention on Tobacco Controlin2003,theGlobal Strategy on Diet, Physical Activity and Health in2004,and the2008-2013 Action Plan for the Global Strategy for the Prevention and Control of NCD in2008andcalledon itsMemberStatestodevelopnationalpolicyframeworkandimplementactionstotackletheissue.

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1. Introduction

Prevalence of NCD and their risk factors in Hong Kong

1.4 HongKong’shealth indices rankamong thebest in theworld. Likemanyplaces,however,anincreasingdiseaseburdenfromNCDisevidentowingtothechanges inhealthriskprofilewiththeexpandingandageingpopulation,socialchangesandglobalisation. Forexample, theproportionofregistereddeathsattributed tocancer,heartdiseasesandstrokehad increased from12.2%,9.4%and7.5% in1961 to30.0%,16.3%and8.9%respectively in2008.

1.5 Among41530registereddeaths in2008,over three-fifthswereattributedtosixmajorbutpreventableNCD, includingcancer(30.0%),heartdiseases(16.3%),stroke(8.9%),chronic lowerrespiratorydiseases(5.1%), injuryandpoisoning(4.3%)anddiabetes(1.3%). The importanceof thesesixmajorNCDisalsounderlinedintermsofhospitaldischargesanddeaths.Altogether,theyaccountedfor21.5%(orabout351438episodes)ofallhospitalinpatientdischargesanddeathsin2008.

1.6 Regarding thebehavioural risk factorssuchasoverweightandobesity,inadequate intakeof fruitandvegetables,physical inactivity,andalcoholmisuse,theBehaviouralRiskFactorSurvey(BRFS)April2009reportedthatabouttwo-fifths(38.7%)ofpeopleaged18-64wereoverweight/obese;aboutfour-fifths(79.0%)failedtomeettheWHOrecommendationofhavingatleastfiveservingsof fruitandvegetablesperday;aboutone-fifth (21.0%)wereclassifiedashaving “low” levelofphysicalactivity (basedon InternationalPhysicalActivityQuestionnaireclassification);andaroundoneintwelve(8.4%)hadbingedrinking. Theabovefindingshaverevealedthat thebehaviouralriskfactorsofNCDarecommoninthelocaladultpopulation.

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Strategic framework for prevention and control of NCD in Hong Kong

1.7 There is convincingevidence that significanteconomicbenefits canbeachievedbypreventingNCDin thecommunity throughhealthpromotion toaddressthemajorriskfactorsofNCD.TohaltandreversethetrendinNCD,astrategicapproachwithconcertedeffortsandeffectivemeansisrequired.

1.8 In thisconnection, theDepartmentofHealth (DH)published thestrategicframeworkdocumententitled “Promoting Health in Hong Kong: A Strategic Framework for Prevention and Control of Non-communicable Diseases” on 28October2008.Theoverallgoalof thestrategicframework is to increasethepositivehealthandqualityoflifeofthepeopleinHongKong.Tooptimisehealthgains,thestrategicframeworkfocusesonthemajorriskfactorsthatarepotentiallymodifiableandhavesignificant impactonthehealthof theHongKongpopulation.

1.9 Six strategicdirectionshavebeen identified for focusing theattention,resourcesandactionswithaviewtoachievingtheoverallgoalofthestrategicframework.Theseinclude:

(i) Support newandstrengthenexistinghealthpromotionandNCD preventioninitiativesoractivitiesthatareinlinewiththisstrategy;(ii) Generateaneffective informationbaseandsystem toguideaction acrossthediseasepathway;(iii) Strengthen partnership and foster engagement of all relevant stakeholders;(iv) BuildupthecapacityandcapabilitytocombatNCD;(v) EnsureahealthsectorthatisresponsivetotheNCDchallengesandto improvethesystemofcare;and(vi) Strengthenanddevelopsupportivehealthpromotinglegislation.

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1. Introduction

Implementation of the strategic framework and establishment of Working Groups

1.10 Tosteerand take thematter forward,ahigh-levelSteeringCommitteeonPreventionandControlofNCD(SC)wasestablished todeliberateonandoverseetheoverallroadmapandstrategy,includingthesettingupofWorkingGroups(WG) toadviseonspecificpriorityareas. TheSC,chairedby theSecretaryforFoodandHealth,comprisesrepresentativesoftheGovernment,publicandprivatesectors,academiaandprofessionalbodies, industryandotherkeypartners.

1.11 TheSCrecognises that the issuesof tobaccocontrolhavebeenactivelytackledbytheTobaccoControlOfficeof theDH,theHongKongCouncilonSmokingandHealthandotherorganizations. Thus theSCconsiders thatWGshouldbesetuptotackleotherimportantbehaviouralriskfactorsofNCD.UnderthesteeringoftheSC,thefirstWGwasestablishedinDecember2008totackletheimminentproblemscausedbyunhealthydietaryhabits,physicalinactivityandobesity.ThesecondWGwassetupinJune2009totackletheproblemsrelatedtoalcoholmisuse.AnotherWGwillbesetuptotackletheproblemsrelatedtoinjuries.

1.12 UnderthechairmanshipofProfessorAlfredCHANCheung-ming,theWorkingGrouponDietandPhysicalActivity (WGDPA)hasbeensetupwith17membersrepresentingthekeystakeholdersinthepublicandprivatesectorsincluding theacademia,districtcouncil,educationsector,businesssector,food industry,healthcareprofessionals,socialservicessectorandrelevantgovernmentdepartments.ThemembershipoftheWGDPAislistedinAnnex1.

1.13 TheWGDPAadvisesonthepriorityareasforaction,anddrawsuptargetsandactionplansrelatedtoissuesofdiet,physicalactivityandobesityfortheSC’sconsideration.ThetermsofreferenceoftheWGDPAislistedinAnnex2.

1.14 Since itsestablishment inDecember2008,WGDPAhadmetfour timesandthetopicsdiscussedarelistedinAnnex3.

2.Diet,physicalactivityandhealth:HongKongsituation

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2 Diet, physical activity and health: Hong Kong situation

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22.1 Weightgain isaconsequenceof the imbalancebetweenenergygained

fromfoodorbeveragesandenergyexpended innormalbodyfunctioningordailyactivities. Therising trendofoverweightandobesityhas largelybeenattributed tounhealthydietaryhabits,wideavailabilityofhigh fatandsugary foods, lackofphysicalactivityandengagement insedentarylifestyles. Inthefollowingparagraphs, the localprevalenceofmajorNCDriskfactors includingdietaryhabit,physicalactivityandoverweight/obesityarereviewed.Furthermore,thelocalhealthpromotionactivitiesconductedbydifferentgovernmentdepartmentsandnon-governmentalorganizations(NGOs)arealsopresented.AlltheseinformationisessentialforidentifyingthepriorityareasforactionandguidingtheinterventionsonNCDpreventionandcontrolinfuture.

Local situation of dietary habit, physical activity participation and overweight/obesity

Dietaryhabit

2.2 For infant and toddlers, there is growing evidence suggesting thatbreastfeedingcanpreventsubsequentchildhoodoverweightandthatlongerbreastfeedingperiodgivesgreaterprotectionforchildren.Itwasestimatedthat thepercentagesof newbornsever breastfedondischarge fromhospitalsrosefromabout10%in1981toaround76.9%in2009.Theeverbreastfeedingrateincreasedfrom50%forbabiesbornin1997to73.7%forthoseborn in2008.Theexclusivebreastfeedingrateforover4-6monthsincreasedfrom6%forbabiesbornin1997to12.7%forthosebornin2008.However,forotherdietaryhabitsamonginfantandyoungchildren,thereislimitedinformationavailable.


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2.3 According to the“AssessmentofDietaryPattern inPrimarySchools2008”conductedby theCentralHealthEducationUnit (CHEU)of theDHin2008toassess thedietaryhabitofP4andP5students, therewasadefiniteknowledge-attitudegapwhere healthy eating is concerned. Studentspossessedgoodknowledgeofhealthier foodoptionsdidnotnecessarilysynchronisewithwhattheychoseinfoodpreference.Onlyabouthalfhadahabitofeatingfruit(57.5%atetwiceormoreperday).Besides,only9.8%to25.6%ofthestudentsdidnotconsumefooditemssuchasdrinkswithaddedsugar,deep-fried food, foodhigh in fat/sugar/salt in theweekprior to thesurvey. Furthermore,studentsshowedpreferencefor food itemsthatwereusuallyhighinsalt,sugarorfat,suchasburgerandfries,ice-creamandhotdog.

2.4 TheWHOrecommends400g intakesof fruitandvegetables foradultsperdayfor thepreventionofchronicdiseases. TheBRFSApril2009of theDHrevealedthataboutfour-fifths(79.0%)ofpeopleaged18-64failedtomeettheWHO’srecommendation in2009. Males(85.3%),youngadultsaged18-24(85.6%)andclerks(84.4%)hadthehighestprevalenceofinadequatefruitandvegetableconsumption.

2.5 TheBRFSApril2007also revealed thatasubstantialproportionof localpopulationateout forbreakfast (30.2%), lunch(51.5%)anddinner(10.8%)fiveormoretimesaweekin2007.AccordingtotheBaselineSurveyforthe"[email protected]"Campaignof theDH in2007,84.5%and53.9%ofpeopleaged12andaboverespectivelyperceivedthat fruitandvegetableingredientswere too little in foodprovidedby foodpremises. Ontheotherhand,60.1%,40.9%and27.2%respectivelyperceived that fat/oil,saltandsugaringredientsweretoomuchinfoodprovidedbyfoodpremises.

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2.6 The“BetterHealthforBetterHongKong”Campaignwasaterritory-wideheathpromotioncampaign launchedfrom2000to2006bytheHealthInfoWorldofHospitalAuthority(HA).Healthcheck-upwasalsoprovidedtotheparticipantstoassesstheirgeneralhealthstatus.From2000to2002,over4500subjectswererecruited fromtwo local labourunions toattend thehealthcheck-up,and thedatawereanalysedandpublished inseveralstudies. Fordietaryhabit,overhalfoftheparticipantshadatleastoneofthesixunhealthydietaryhabits(nodailyfruitintake,nodailyvegetableintake,lowfluidintake,havingirregularmeals, frequentsugarydrinksandfrequentdiningout)andaround20%hadmore thanoneunhealthydietaryhabit. Overall,menhad lessdesirabledietaryhabitthanwomen.1

2.7 Forelderlypopulation, thePopulationHealthSurvey (PHS)2003/2004showedthat79.5%and76.5%ofpeopleaged65-74andaged75andaboveconsumedlessthanfiveservingsoffruitandvegetablesperdayrespectively.

Physicalactivityparticipation

2.8 Thesurveysof theEducationBureau (EDB)onstudents’physical fitnessshowed thatother thanPhysicalEducation lessons, less thanhalfof thestudentsengagedinmoderateexerciseforatleastthreetimesperweekwith20minutesormorepersession(i.e.48.1%forP1-3and50.0%forP4-6 in2003/04;40.1%forS1-3and30.1%forS4-7in2004/05;and40.8%forP1-3and42.2%forP4-6 in2005/06). The2004/05studyalsofoundthat46.4%of juniorsecondaryand40.5%ofseniorsecondarystudentsspentoverfourhoursdailywatching television,videos,using thecomputerorplayingcomputergames.

2.9 In theStudyontheParticipationPatternsofHongKongPeople inPhysicalActivitiesof theCommunitySportsCommittee(CSC),61.2%ofrespondentsaged7-12(i.e.mostlyprimarystudents)and57.4%ofrespondentsaged13-19(mostlysecondarystudents)engagedinthreedaysormoreof30minutesofmoderatetovigorousactivityweekly,excludingPhysicalEducationlessons.Althoughthe figuresarehigher than those inparagraph2.8, there ismuchroomforimprovement.

1KoGT,etal.AssociationsbetweendietaryhabitsandriskfactorsforcardiovasculardiseasesinaHongKongChineseworkingpopulation-the"BetterHealthforBetterHongKong"(BHBHK)healthpromotioncampaign.AsiaPacificJournalofClinicalNutrition2007;16:757-65.


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2.10 According to theBRFS in2009,around85.9%ofpeopleaged18-64didnothavevigorousphysicalactivity for threedaysormoreperweek;about75.5%didnothavemoderatephysicalactivity for threedaysormoreperweek;around29.0%didnotwalk for10minutesdaily. Overall,aboutone-fifth(21.0%)wereclassifiedashaving“low” levelofphysicalactivity(basedonInternationalPhysicalActivityQuestionnaireclassification). Clerksweremorecommon tobeclassifiedashaving “low” levelofphysicalactivity.Furthermore, fromPHS2003/2004 findings,20.9%ofpeopleaged15andabovesatat least10hoursdailyandpeople inyoungeragegroup(15-34)spentmoretimeonsitting.

2.11 Accordingto theSportsParticipationSurvey2001of theHongKongSportsDevelopmentBoard,48%ofpeopleaged15andabovehadparticipatedinatleastonesportsactivityinthepastthreemonths.Peopleaged15-24(65%)had thehighestparticipation rate,while thoseaged55-64had the lowest(31%).

2.12 Forelderlypopulation,8.3%and16.6%ofpeopleaged65-74andaged75andaboverespectivelydidnotwalk for10minutesdailyaccording toPHS2003/2004.Furthermore,18.7%and30.9%ofpeopleaged65-74andaged75andaboverespectivelywereclassifiedashaving“low” levelofphysicalactivity. FromtheSportsParticipationSurvey2001,49%ofpeopleaged65andabovehadparticipated inat leastonesportsactivity in thepast threemonths.

Overweight/obesity

2.13 Accordingtostatisticsof theStudentHealthService(SHS), theprevalenceofoverweight includingobesity(definedasmorethan120%medianweightforheight)amongprimaryschoolstudents rose from16.4% in1997/1998schoolyearto22.2%in2008/2009schoolyear. Similarly, theprevalenceofoverweight includingobesityamongsecondaryschoolstudents rose from13.6%to17.7%in thesameperiod. Overall, theprevalenceofoverweightincludingobesityamongstudentsrosefrom15.7%in1997/1998to20.4%in2008/2009.Theprevalenceremainedhigheramongboyswiththedifferencebetweenboysandgirlswideningslightlyover theyears. It isclear that thecohortwithahigherbaselineprevalenceofobesitywillendupwithahigherprevalenceofobesitywhentheyleaveschools(bothprimaryandsecondary).

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2.14 From2003to2004,theChineseUniversityofHongKong(CUHK)conductedacross-sectionalstudy toexamine theprevalenceofoverweight/obesityamong local studentsaged11-18.2 Theweight andheight of around

2100studentsfrom14schoolsweremeasured.Thestudyrevealedthattheprevalenceofadolescentoverweight/obesityrangedfromabout10%to14%basedondifferent internationalclassification. Theproblemofoverweight/obesitywasmorecommonamongboysthangirls(boys:14%-20%;girls:7%-10%).

2.15 Another cross-sectional studyofCUHK,whichexaminedaround2600childrenaged6-13,revealedthatabout13%ofboysand11%ofgirlswereobese.3 Furthermore,about10%and3%ofthechildrenwereclassifiedashavingthreeormoreandfourormoreof thesixcardiovascularrisk factors(highsystolicbloodpressure/diastolicbloodpressure,highbloodtriglyceride,lowbloodhigh-density lipoprotein,highblood low-density lipoprotein,highbloodglucoseandhighbloodinsulin)respectively.

2.16 Foradultpopulation, theBRFS revealed that38.7%ofpeopleaged18-64wereoverweight/obese(definedasbodymass indexgreater than22.9)in2009. Weightproblemwasmorecommonamongmales than females(male:49.3%; female:29.7%). Peopleaged35oraboveandbluecollarworkershadthehighestprevalenceofoverweight/obesity.Overallspeaking,theprevalenceofoverweight/obesity remainedstable from2004 to2009.However,anincreasingtrend(46.0%in2004to49.3%in2009)ofoverweight/obesitywasobservedamongthemalepopulation.

2.17 Analysingthedatafromthe“BetterHealthforBetterHongKong”Campaign,itwasrevealedthattheage-standardisedpercentageofoverweight/obesityandcentralobesityamongtheparticipatingworkingpopulationwererespectivelyaround60%and27%inmen,and32%and27%inwomen.Comparedtothedatacollectedfromalocalprevalencesurveyforglucoseintoleranceandlipidabnormalityin19904,thepercentageofcentralobesitydoubledinmen(12%to27%)butremainedsimilarinwomen.5

2KoGT,etal.Theproblemofobesityamongadolescents inHongKong:acomparisonusingvariousdiagnosticcriteria.BMCPediatrics2008;8:10.3SungRYT,etal.WaistcircumferenceandbodymassindexinChinesechildren:cutoffvaluesforpredictingcardiovascularriskfactors.InternationalJournalofObesity2007;31(3):550-8.4CockramCS,etal.Theprevalenceofdiabetesmellitusand impairedglucosetoleranceamongHongKongChineseadultsofworkingage.DiabetesResearchandClinicalPractice1993;21:67-73.5KoTC,etal.Doublingover tenyearsof centralobesity inHongKongChineseworkingmen.ChineseMedical Journal2007;120(13):1151-4.


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2.18 Furthermore,overaquarterofthesubjectshadmorethanonecardiovascularr isk factor (smoking, being obese, having hypertension, havinghypercholesterolaemia,havingdiabetesmellitus,pasthistoryofcardiovasculardiseases). Despite thishighprevalenceofmultiplerisk factors,most(83%)perceivedtheirhealthassatisfactory.6

2.19 Forelderlypopulation, thePHS2003/2004revealed that theprevalenceofoverweight/obesitywas49.4%and41.9%forpeopleaged65-74andaged75andaboverespectively.

Local health promotion activities to promote healthy lifestyles

HealthpromotionprogrammesbytheDepartmentofHealth

2.20 TheDHhascommittedtosafeguardingthehealthof thecommunitythroughpromotive,preventive,curativeandrehabilitativeservices.TheDHpromoteshealthy livingto thegeneralpublic throughvariouschannels. Thefollowingparagraphssummarisetheseactivities.

2.21 TheNCDDivisionof theDH is responsible forsurveillanceandcontrolofNCDofpublichealth importanceinHongKongandformulationofstrategiesinrelationtoNCDprevention.ThroughBehaviouralRiskFactorSurveillanceSystem,PublicHealth InformationSystemandotherhealthsurveys, theDivisionregularlycollects,collates,analysesanddisseminatessurveillancedataonNCDandtheirrelatedriskfactors.Theinformationcollectedisusefulforplanning, implementingandevaluatinghealthpromotionprogrammes,for development ofNCDpreventionand control activities, and for riskcommunicationthroughamonthlypublication“NCDWatch”.

6KoGT,etal.Lowlevelsofawarenessofsuboptimalhealthconditionsinahigh-riskworkingpopulation:the"BetterHealthforBetterHongKong"healthpromotioncampaign.InternationalJournalofBehaviouralMedicine2007;14:63-9.

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2.22 TheCHEUof theDHpromotes the health of the community throughcollaboratingwithvariousagencies inhealthpromotion. Topromotehealthyeatinghabit, theCHEUhasallalongcommittedtoraisingpublicawarenessof the importanceofhealthyeating throughvarious large-scalecampaignssuchas“2Plus3ADay”Campaign,“[email protected]”Campaignand“[email protected]”Campaign.The“[email protected]”Campaignwas launched in2006-2007academicyear to raisepublicawarenessandconcernabouthealthydietamongchildren,andcreateanenvironment thatisconducive tohealthydiet inschoolsand thecommunity. In2007, the“[email protected]”Campaignwasalso launchedtopromotehealthyeating inrestaurantsaspartof theeffortstoaddressNCDandobesity;alsoto formulateand implementstrategies toempower thepublic tomakeandrequesthealthierchoiceswheneatingout.Forpromotingphysicalactivity,theCHEUcollaboratedwithdifferentgovernmentdepartments,non-governmentorganizationsandprofessionalbodies to launchvarious initiativessuchas“HealthyExerciseforAllCampaign”,“ExercisePrescriptionProject”and“StairClimbingtoHealth”.

2.23 Through theCommunity LiaisonDivision, theDH establishes closepartnershipswithDistrictCouncils,HealthyCityProjects,communitygroupsand thepublic toorganizehealthpromotionprogrammesandpromotepopulationhealth.

2.24 TheFamilyHealthService(FHS),SHSandElderlyHealthService(EHS)oftheDHprovideavarietyofhealthpromotionanddiseasepreventionactivitiesforpeopleindifferentlifestages.


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2.25 TheFHSprovidesacomprehensiverangeofhealthpromotionanddiseasepreventionservices for children frombirth to5yearsandwomenbelow65yearsofage. Theseservicesareprovided throughanetworkof31MaternalandChildHealthCentres(MCHCs)and3WomanHealthCentres.Furthermore, theFHShasbeenactively involved inpromoting,protectingandsupportingbreastfeeding. Since2000,abreastfeedingpolicyhasbeen implemented in theFHS to facilitateasupportiveenvironment inallMCHCs.AllmedicalandnursingstaffofFHSweregivenstructuredtraininginbreastfeedingcounselling. SinceAugust2002, theDHhas implementedadepartmentalpolicy topromotebreastfeedingamongallstaffandsupportbreastfeeding in theworkplace. Information kits onbreastfeedingareproducedanddistributedtopregnantwomeninantenatalclinicsofhospitalsandMCHCs. Everyyear, theFHS joinsupwithothercommunitypartnersin launchingpublicitycampaignsaround theWorldBreastfeedingWeek toraisepublicawarenessonbreastfeeding.TheFHSalsomonitorsthetrendoflocalbreastfeedingratethroughcollectingmonthlyreportsfromallpublicandprivatematernityunitsandconductingregularsurveysintheMCHCs.

2.26 TheSHSaims tosafeguardboth thephysicalandpsychologicalhealthofschoolchildren throughcomprehensive,promotiveandpreventivehealthprogrammestoenablethemtogainthemaximumbenefitfromtheeducationsystemanddevelop their fullpotentials. TheSHSoperates12StudentHealthServiceCentres,whichprovidesservicessuchashealthassessment(e.g.weightstatusmeasurement),healtheducation(e.g.onhealthyeating,physicalactivityparticipation)andindividualhealthcounsellingforallprimaryandsecondaryschoolstudents.

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2.27 TheEHSprovidesprimaryhealthcare to theelderlysoas to improvetheirself-careability,encouragehealthy livingandstrengthen familysupport inorder tominimise illnessanddisability. Itoffers integratedhealthservicesincludinghealth riskassessment,physicalcheck-ups,counselling,curativetreatmentandhealtheducationtoelderlypeopleaged65andabovethroughits18ElderlyHealthCentres. Tailoredhealtheducationwillbegiven tothosewithhealthrisks,suchasoverweight,sedentary lifestyleorunhealthydiets,whicharedetectedthroughhealthriskassessment.Collaboratingwithvariouselderlycareproviders, the18VisitingHealthTeams(VHTs) reachintothecommunityandprovidehealtheducationforeldersandtheircarers.TheVHTsconducteducationaloutreachvisits toresidentialcarehomesfortheelderly toprovideskill trainingfor theirstaffontopicssuchasdesigninghealthymenus forelders,enhancing fiber intakeof residents,assessingresidents’nutritionalstatus.TheEHSactivelydisseminateshealthinformationtothegeneralpublic,includingtopicsondietandexercise,throughpamphlets,internetwebpages, telephone informationhotlines,mediaprogrammesandinterviews,andcontributedarticlestonewspapers.Topromotehealthyeatingandexercisesforall, theEHShasproducedvariousVCDssuchas“HealthySnacks”,“ShoppingSmart”,“ExerciseforHealthyAgeing”and“MaintenanceExercisefortheFrailElders”.TheEHShasalsopublishedaseriesofbooksincluding “CookbookofHealthyRecipes”and “OnHealthyEating:TheScienceandLoveofFoodandEating”,whichfurtherpromulgatetheprincipleofhealthyeating.

Health promotion programmes by other government departments and localorganizations

2.28 Apart fromtheDH,othergovernmentdepartmentssuchastheLeisureandCulturalServicesDepartment (LCSD)andEDBalsoplayamajor role inpromotinghealthy lifestyles. Many localNGOsalsoactivelyparticipate inpromotinghealthy living. Basedonthe input fromWGDPAMembers,some50localhealthpromotionprogrammeswereidentifiedandlistedinAnnex4.


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2.29 In accordancewith theOttawaCharter forHealthPromotion, healthpromotion isdefinedas“theprocessofenablingpeople to increasecontroloverand to improve theirhealth”. For thisprocess tomakean impactonpopulationhealth, thesixelementsofPEOPLE,namelyPartnership,Environment,Outcome-focused,Population-based,Life-courseapproachandEmpowerment,areconsideredasthecoretoplanningandimplementationofthehealthpromotionprogramme.Usingthesesixcriteria,someexamplesofhealthpromotiongoodpracticesareidentifiedandoutlinedbelow.

JumpRopeforHeartProgram

2.30 TheHongKongCollegeofCardiologyhaslaunchedthe“JumpRopeforHeartProgram”in1999tomotivateyoungpeopletoadoptahearthealthy lifestylethroughhavingphysicalactivity, thusreducingtheriskofheartdiseasesandstroke.Theprogrammecomprisesfourcomponents:-• Teachingskippingskillsthroughprovisionofasetofteachingkitwithguide

books,ropes,DVDs,andposterstoparticipatingschools;• ProvidingHeartHealthEducation throughhealth talksbycardiologists,

distribution of health educationmaterials, slogan/poster designcompetitions,etc;

• FundRaisingwhich isused foroperating the “JumpRope forHeartProgram”andorganizinghearthealthpromotionalactivities. 15%of thefund raisedwillbeallocated toparticipatingschools for theexpensesoforganizing the “JumpOffDay”andotherhealth-relatedactivities.Furthermore,studentscanhelptodisseminatethehearthealthmessageto their relativesand friendsduring fund raising. Besides, the fundraisingmechanismof the “JumpRope forHeartProgram”assures itssustainability;and

• Organizing“JumpOffDay”byparticipatingschools for theirstudents toperformskippingskillssothatmorestudentswillbemotivatedto jointheprogramme.

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HongKongHealthySchoolsAwardScheme

2.31 TheCentre forHealthEducation andHealthPromotion ofCUHKhaslaunched theHongKongHealthySchoolsAwardScheme forprimaryandsecondaryschoolssince2001. TheScheme followsclosely theHealthySchoolsProgrammepromotedby theWHO. TheSchemecoverssixkeyareas, includinghealthpolicies,health services,personalhealth skills,socialenvironment,community relationshipsandphysicalenvironment. Itbuildson theconceptofhealthpromotingschool toencourageeducationalachievement,betterhealthandemotionalwell-being; therebysupportingstudents in improvingtheirqualityof life. Itprovidesastructuredframeworkfor the development and implementation of healthy schools. A set ofguidelinesandstandardswithindicatorsformonitoringschools’progressandrecognitionofachievementareadopted.TheorganizerhasrecentlylaunchedtheHongKongHealthyPre-SchoolsAwardSchemetopromotehealthamongpre-schoolchildren. TheSchemehasobtainedpartof its funding fromtheQualityEducationFund.

2.32 Theaboveprogrammescomprise thesixkeyelements for implementationofhealthpromotionprogramme. Theorganizerscloselycollaboratewithvariouspartiessuchas theEDB,DHandparticipatingschools tocarryouttheprogrammes.Thisdrawstogetherthestrengthsofpeoplefromdifferentsectorswithdiverseknowledgeandskills.Theprogrammesadoptthesettingapproachandpromotehealthy living inschools, thuscreatingasupportiveenvironmentwhichenablesstudents tocultivate thehabitofhealthy living.Clearguidelinesandmeasurable indicatorsareestablishedtogaugeschooldevelopmentandmonitortheprogress.Theyareterritory-wideprogrammestargetedforallschoolsinHongKong.TheprogrammespromotehealthylivinginchildrenwhichmayhelptoreducetheriskofhavingNCDintheiradulthood.Furthermore, theprogrammesalsoempowerstudentswithpersonalhealthskills,andequiptheschoolmanagementswithskillstocreateanenvironmentthatisconducivetostudents’health.


19

Analysis

Unhealthydietaryhabit,physicalinactivityandoverweight/obesityareprevalentinthelocalpopulation

2.33 Datafromvarioussourceshaverevealedthatunhealthydietaryhabit,physicalinactivity,andoverweight/obesityarecommonatdifferent lifestagesof thelocalpopulationstartingfromschoolage.

2.34 Fordietaryhabit, theWHOrecommendsexclusivebreastfeedingup to6months fornewborns. Althoughmany infants inHongKonghavebeenbreastfedondischargefromhospital,theexclusivebreastfeedingrateremainslow. Unhealthydietaryhabit isalsocommonamongchildrenandadults.Manychildrenshowpreferenceandconsumeunhealthyfoodsuchassugarydrinksanddeep-friedfood.Similarly,majorityofadultshavecertainunhealthydietaryhabitssuchas inadequate fruitandvegetablesconsumption,andfrequentsugarydrinks. Overall,unhealthydietaryhabit ismorecommonamongmales.

2.35 Physical inactivity isprevalent in the territory. Localstudiesshowed thatabouthalfofthestudentsdidnotexerciseenough.Ontheotherhand,theyspentasignificantproportionoftimeonsedentaryactivitiessuchaswatchingtelevisionandsurfing internet. Foradultpopulation,aboutone-fifthareclassifiedashaving“low” levelofphysicalactivityandoverhalfof themdidnotparticipate inanysportsactivity inthepast threemonths. Similar tothechildrenpopulation,adultsspendalotoftimeonsedentaryactivitiessuchassitting.Ingeneral,femalesarelessactivethanmales.

2.36 Theprevalenceofoverweight/obesity isontherisingtrendinHongKongforbothchildrenandadults. Asunhealthydietaryhabitandphysical inactivityare risk factors foroverweight/obesity, it isnotdifficult tounderstand thereasonbehind. Overall,overweight/obesity ismorecommonamongmales.Furthermore, thepresenceofcardiovascularrisk factorssuchashighbloodpressureandadverselipidprofilearenotuncommonamongbothchildrenandadultpopulation.

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Informationgapon localepidemiologyofunhealthydietaryhabitandphysicalinactivity

2.37 It isclear that theunhealthy lifestylespracticesarecommon in the localpopulation.However,information on the prevalence of unhealthy dietary habit and participation in physical activity among children, especially infants and young children, remains inadequate.

2.38 Severalgovernmentdepartmentsareconductingpopulation-basedsurveysrelated to thedietaryhabitandphysicalactivityparticipationof the localpopulation. Forexample, theStudyon theParticipationPatternsofHongKongPeople inPhysicalActivities isbeingconductedby theCSCof theSportsCommissiontoexaminethepatternsofphysicalactivityparticipationbythelocalpopulationagedsevenandabove.TheFoodConsumptionSurvey2005-2007and theTotalDietStudy(TDS)of theFoodandEnvironmentalHygieneDepartment (FEHD)arebeingconducted tocollect informationonthefoodconsumptionpatternsofthelocaladultpopulation.Whiletheabovestudiesareexpected toshed lighton thebehaviouralandbiomedical riskfactorsaffecting thepopulationat large, information focusingon infantandyoungchildrenremainslimited.

2.39 On theotherhand, theDHhasconducted the firstpopulation-basedChildHealthSurvey tocollecthealth informationof localchildrenaged14andbelow,suchashealth-relatedbehaviours,healthstatusandparentingissues.While theChildHealthSurveyof theDHmayaddtothecurrentknowledgeonhealthstatusof infantsandyoungchildren, thesurveyhasnotbeenspecificallydesignedforcollectingdataondietaryhabitandphysicalactivity,andtheinformationgeneratedfromthesurveymaynotbecomprehensivetoguideinterventionsthatfocusonchildren’sdietaryhabitandphysicalactivity.Moreinformationonthisareaisrequiredtobetterdefinetheirhealthneeds.

2.40 Besides,majorityof local studies focuson revealing theprevalenceofunhealthydietaryhabit,physical inactivityoroverweight/obese. Information on the knowledge, attitude and practice, as well as incentives and barriers to people’s adoption of healthy lifestyles is limited. Thus, it isdifficulttoidentifypeople’srootreasonsofhavingtheseriskfactors.


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Gaponlocalhealthpromotionactivities

2.41 As canbe seen fromAnnex4, local health promotion activities are varied in nature and majority are organized independently by various organizations with minimal coordination among them. Activities tendtopromotehealthy living,withschoolchildrenandadultsasthemaintargetgroups.Furthermore,despitethelackofdetailedinformation,the small scale and short-term nature of some of the local health promotion activities might imply a limited impact on improving population health.

2.42 Besides,health promotion activity targeting at young children is apparently scanty. Individualsare influencedby factorsactingat allstagesof lifeand the risksofdevelopingNCDaccumulatewithage. Agoodandhealthystart in lifecreatesastrongplatform for thehealthoflater life. Byutilisingopportunitiesatearly lifestages, itmaybepossibletoachievereduction inprematuredeathsand fewerdisabilities inadulthood.Furthermore, it is fareasier toestablishgoodpatternsofactivityandeatinghabit than tochangeunhealthyhabits thathavebecome ingrained. Thus,interventionthatpromoteshealthinearlylifeisimportantinreducingtheriskofNCDinlateryears.

2.43 According to theWHO, theworkplacehasbeenestablishedasoneof theprioritysettings forhealthpromotion into the21stcentury. Theworkplaceisnotonlyoneof theplaceswheremostof thetimeisspent; italsodirectlyinfluencesthephysical,mentalandsocialwell-beingofworkersandinturnthehealthof their familiesandcommunities. TherearemorethanthreemillionpeopleworkinginHongKongandworkplaceoffersanidealsettingtopromotehealthy lifestyles fora largeaudience. However,activities to promote healthy living in workplace for the working population are also limited.

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TheroleofNGOsandbusinesssectorinpromotinghealth

2.44 TheOttawaCharter forHealth Promotion presented by theWHO in1986 recommended thathealthpromotion liesbeyond thehealthsector,emphasisingthat individualshavetotakegreaterresponsibility for theirownhealth. The importanceofpartnership forhealthpromotionwasreiteratedinWHO’sThe Bangkok Charter for Health Promotion in a Globalized World issuedin2005(informationontheconceptsandpracticeofhealthpromotionasanapproachand tool to improvingpeople’shealth isattached inAnnex5).IntheWestern Pacific Regional Action Plan for NCD,theRegionalOfficefor theWesternPacificofWHOalsourgedMemberStates toencourageandpromotecommunityparticipationandgrassrootsmobilisationsoas toestablishabroadbaseofsupport forpreventionandcontrolofNCDandtoensureacceptabilityandeffectivenessofpolicyandpopulation-basedinterventions. Thepublichealth issueofoverweight/obesity inHongKongthuscannotbe tackledsolelyby thehealthcaresystem,governmentorhealthcareworkers.Jointparticipationofallsectorsisthekeytosuccess.

2.45 ManyNGOsworkfor thewelfareof thecitizensand long-termsustainabilityof thesociety. Theyvaluesocial justiceandequality,andthe intrinsicrightsofevery individual. Whilesociety isobliged toprovide individualswith thebasicsocialandeconomicresourcestodeveloptheirpotentials,manyNGOsencourageindividualstocarryout theirresponsibilitiestowardstheir familiesandsociety,tobeself-reliantandtoachieveself-actualisation.Infact,manyNGOssharecommonvaluesinhealthpromotionbymotivatingthecommunitytotakeresponsibilitiesforhealthandempoweringindividualswithknowledgeandskills tomakehealthierdecisions forhealth,whilebeingmindfulof theneed tominimise thehealthequitygap. Thuson topof theeffortsby theGovernment,NGOs’participationandsupportinhealthpromotionisessentialtoenhanceitseffectiveness.

2.46 InHongKong,about52%ofthepopulationisinthelabourforceandpeoplespendmore thanone-thirdof thedaily lifeatwork. At individual level,promotinghealth inworkplacecan improvethewell-beingof theemployeeswhichwillenhance theirproductivity. Assuch,ahealthyworkplacewillbeimportant forsustainablesocialandeconomicdevelopment. On theotherhand,unhealthyworkforceresults ineconomic lossesthroughabsenteeism,injuryanddisease,directand indirecthealthexpenditures,andsignificantsocialcoststofamilies,communitiesandsociety.Therefore,thecommitmentandcontributionfromthebusinesssector is indispensable in improvingandprotectingpopulationhealth.

3.Actionstopromotehealthydietandphysicalactivityparticipation

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3Actions to promote healthy diet and physical activity participation

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3Preamble

3.1 It isenvisioned thatwith thesuccessful implementationof theStrategicFramework forNCDPreventionandControl,HongKongwillhaveawell-informedpopulation that isable to takeresponsibility for theirownhealth,acaringcommunity that integrates thepublicandprivatesectors toensurehealthychoicesfor thepublic,acompetenthealthcareprofessionthatviewshealthpromotionandpreventivemedicineaspriorities,andasustainablehealthcaresystem that incorporatesstrongelementsofhealthpromotion,diseasepreventionandcurativecare forourpeople, therebysignificantlyreducingthetollofdiseaseburdenrelatedtoNCD.

3.2 Toachievetheabovevision,WGDPArecognisestheimportanceofconcertedeffortsof theGovernmentanddifferentsectors in thecommunity inorder tocreateasustainableenvironmentconducive topromotinghealthydietandphysicalactivityparticipation.Itisofequalimportancethatindividualcitizensshould takeresponsibility for theirownhealth,aswellas thehealthof theirfamiliesandthecommunities,bymakinginformedandhealthierchoiceswithregardtodiet,physicalactivityandotherlifestyles.

3.3 AlthoughWGDPA ismainly tasked to recommendactions to promotehealthyeatingandphysicalactivityparticipation inHongKong,WGDPAalso recognises thesynergistichealthbenefits thatcanbebroughtaboutbymodifyingothermajorbehavioural risk factors includingsmokingandexcessivedrinkingatonego.Therefore,WGDPAwishestocallforcontinuingactionsfortobaccocontrolandavoidanceofexcessivedrinking,inadditiontoadoptionofhealthydietandactiveliving.


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Goals

3.4 Inmakingrecommendationstopromotehealthyeatingandphysicalactivityparticipation,WGDPAaims tohalt therising tideofoverweight/obesityandachievetheultimategoalofpreventingNCDandenhancingthequalityoflifeofthepopulation.Aftercarefulreviewandin-depthdiscussionregardingthelocalsituationonNCDandthemajorriskfactors includingunhealthydietaryhabit,physical inactivityandoverweight/obese,aswellas the localhealthpromotionactivitiesconductedbygovernmentdepartmentsandvariousorganizations inHongKong,WGDPAhasdrawnup thisAction Plan to Promote Healthy Diet and Physical Activity Participation in Hong Kong(ActionPlan).InthisActionPlan,WGDPAsetsoutpriorityareasforaction,anddrawsupalistofproposedactionswithtargetsandtimeframeswhereapplicable.

3.5 Indeveloping thisdetailedActionPlan,WGDPAconsulteddifferent keystakeholders in thepublic andprivate sectors including theacademia,districtcouncils,educationsector,businesssector, food industry,healthcareprofessionals,socialservicessectorandrelevantgovernmentdepartments.Itisintendedtooutlinetheframeworkofactionsthatwillbetakentosupport,andhelpsetthedirectionfor,thedeliveryofhealthpromotionprogrammes.

3.6 Togetherwith thecontinuingactions for tobaccocontrolandavoidanceofexcessivedrinking, thisActionPlanaims tobringaboutsynergistichealthbenefitsbymodifyingmajorbehaviouralriskfactorsandeventuallyreducetheprevalenceandmortalityratesfromNCDsuchasheartdiseases,strokeandcancersinthelongrun.

Details of 30 specific actions

3.7 Toachieve thesetgoalsand in linewith theNCDpreventionandcontrolstrategy, theSCMembershaveendorsedfourpriorityareas foractionwitha totalof11recommendations. Another threerecommendationsaremaderegardingsecuringof resources for theproposedhealthpromotionactions.This section setsout the30 specific actionswesuggest to implementto support people tomake healthier choices in their daily lives. Ourrecommendationshavebeenmadeafterconsultingstakeholdersfromacrosssectors,disciplinesandorganizations,andmost importantlysoliciting theirsupport for implementing therecommendations. The listof recommendedactionsaresummarisedinTable1.

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Priority area 1: Generate an effective information base and system on dietary habit and physical activity participation to guide actions

(Recommendation1A)StrengthensurveillanceofNCDandbehaviouralriskfactors

3.8 ResearchandsurveillanceofNCDandtheirrelatedriskfactorshelpgenerateevidence-basedinformationandinformactions.WGDPArecognisesthatthereisinformationgapregardingthedietaryhabitandphysicalactivityparticipationamong infantsandyoungchildrenand theirsignificantothers. Besides,WGDPArecognisesinadequacyininformationrelatedtotheunderstandingoftrends inunhealthybehaviours, thereasonsfor these,andeffectivewaysofpromotinghealthylivinginthepopulation.

3.9 In thisconnection,WGDPA recommends strengthening surveillance of NCD and tracking changes in the behavioural risk factor profiles of unhealthy dietary habit, physical inactivity and overweight/obesity of the population.Thesurveillancedatawillbeusefulformonitoringthetrendsofhealth-relatedbehaviours,planning, implementingandevaluatinghealthpromotionprogrammes.Currently, theBehaviouralRiskFactorSurveillanceSystemof theDHsystematicallyandregularlymonitorsthetrendsofhealthrisk factors in the localpopulation. The followingparagraphsdescribe thethreespecificactionstargetingthisrecommendation.

Action 1:Conduct a pi lot study on a web-basedYouth-Health BehaviourSurveillanceSystem(Y-HBSS)

3.10 Recognising the importanceofsoundsurveillance information for trackingchanges inhealthbehavioursof theyouth, theDHhasconductedapilotstudy to assess the feasibility andacceptability of usingaweb-basedsurveyquestionnaire tocollecthealthbehaviour informationfromsecondaryschoolstudents.Morethan1300studentsstudyingin8secondaryschoolsindifferentdistricts inHongKonghavebeen invited. Thestudywill becompletedinthesecondquarterof2010.Thestudyresultswillprovideusefulinformationonthefeasibilityofdevelopingaterritory-wideweb-basedY-HBSStomonitorthepriorityhealthbehavioursamongthelocalyouth.SupportfromtheEDBwillbesolicitedtoenhancetheacceptancebythestakeholders.


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Action 2:Explore theuseofgrowthparametersmeasured inschools to trackchangesofobesity

3.11 Atpresent, there isa lackof comprehensivemechanism tocapture theanthropometricmeasurements of students. Noting that schools havebeenmeasuring theheight andweight of their studentsperiodically ineachacademicyear, theDHandEDBwillwork together toexplore thearrangements toallowtheuseofgrowthparametermeasured inschools tomonitorthelongtermtrendofoverweight/obesityinchildrenandadolescentssuchasby issuingguidelines toschoolsandstandardising the instrumentsusedandmethodsofmeasurement.

Action 3:ConductTotalDietStudytoassessdietaryintakeofthepopulation

3.12 Healthyeating isan importantdeterminantofhealth. Imbalanceddiet isassociatedwithsomechronicdiseasesandconditions includingobesity,heartdiseases,hypertension,diabetesandcancers. In thisconnection, theFEHDhascommissionedtheFoodConsumptionSurvey2005-2007,whichisa territory-wideandpopulation-basedstudytocollect informationonfoodconsumptionpatternsof thegeneralpublic. TheFEHDplans to reviewthe findingsof theFoodConsumptionSurvey2005-07 in2010. To furtherassessthedietary intakeof thepopulation,aTaskForceonTDSconsistingofmembersfromvariousgovernmentdepartmentshasbeenestablishedbytheFEHDtodevelopaTDSinHongKong.TheTDSmeasurestheamountofnutrients ingestedbypeopleofdifferentageandsexgroups. Itenablestheidentificationofthepopulationgroupsthataremostatriskandfacilitatestheformulationofactionplanstailor-madeforthespecificgroups.Theactualfieldworkwillbeconducted in2010-11andthe findingsof thestudywillbepublishedinphasesbetween2011-14.

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(Recommendation1B)Conductpopulation-basedhealthsurveyswithreferencetoWHO’s‘STEPS’

3.13 Apart fromstrengtheningsurveillanceofNCD,WGDPA recommends that population-based health surveys with measurement of biomedical risk factors should also be conducted regularly to monitor the health status of local population. Furthermore,NCD and risk factor surveillance should follow the “STEPwise approach to Surveillance (STEPS)” as recommended by the WHO. In the longterm, it is important todevelopamechanismtointegratealllocallyavailablehealthdatafromdifferentsourcesand to facilitatedatasharingamonggovernmentdepartments,academia,healthcareprofessionalsandotherstakeholders.

Action 4:ConductthesecondPopulationHealthSurvey

3.14 TheSTEPSinstruments,asrecommendedbyWHOtomonitor thetrendofchronicdiseaseriskfactors,coverthreedifferentlevelsof“steps”ofriskfactorassessment,includingquestionnaire,physicalmeasurementandbiochemicalmeasurements,e.g.bloodglucoseandbloodlipidprofiles. Inyear2003/04,theDHhascollaboratedwiththeDepartmentofCommunityMedicineof theUniversityofHongKong toconduct its firstPHS to report thepatternsofhealthstatusandhealth-relatedissuesofthegeneralpopulationinHongKongforadultsaged15orabove. It isenvisaged that the informationcollectedevery10yearswouldfacilitateplanning,managementandevaluationofhealthpromotionprogrammes. Hence, theDHplans toconduct thesecondPHSbasedontheWHOSTEPwiseapproach incollaborationwiththeacademia,whichwill takefiveyears tocomplete(from2011to2015). Commissioningofthestudywillstartin2011whilethepilotstudyandtheactualfieldworkwillbeconductedin2012and2013/14respectively.Areportwillbepublishedin2014/15.


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(Recommendation 1C)Promote and support research related to risk factormodificationandeffectiveinterventions

3.15 Todeepen theunderstandingofcausesandconsequencesof the rise inunhealthyeatingandphysical inactivity,andwhatworkstopromotehealthyliving,WGDPA recommends promoting and supporting research in areas related to the behavioural risk factor modification and the effective interventions in promoting healthy eating and physical activity participation. The research resultswill be valuable forguiding futureevidence-basedinterventionsinpromotinghealthyeatingandphysicalactivityparticipationininfantsandyoungchildren.

Action 5: Conductaseriesofsurveyson infantsandyoungchildrenand theirparents

3.16 Lifestylehabitsintheearlyyearsplayacrucialroleinshapinganindividual’seatingandphysicalactivitypatterns. To fill theexisting informationgapsregardingthe lifestylehabitsof infantsandyoungchildren, theDHwill takethe leadtoconductaseriesofsurveysonparentalknowledge,attitudeandpracticeof feeding infantsandyoungchildren,milkconsumptionof infantsandyoungchildren, levelofphysicalactivityof infantsandyoungchildren,andfoodandnutrient intakesof infantsandyoungchildren. DatacollectionandanalysisoftheabovesurveysareexpectedtobecompletedbytheendofDecember2010.TheresultsofthesurveyswillbepublishedinMarch2011.

Action 6:Conduct reviewon theexistingprovisionof recreationand sportsprogrammes

3.17 ProvisionofawidevarietyoforganizedrecreationandsportsprogrammesisakeymeasureoftheLCSDtopromotesportstothecommunityatlarge.Theseprogrammesserve theobjectivesof fosteringastrongersportingculture,arousingpublicawarenessof thebenefitof regularparticipation inphysicalactivities,enhancingourqualityoflifeaswellassocialsolidarity.Inordertoenhancetheprogrammemixandtodesignmorenewprogrammestocaterfortheneedofdifferenttargetgroups,theLCSDplanstoconductareviewontheexistingprovisionofrecreationandsportsprogrammesin2010-14withaviewtoprovidingmoreattractiveprogrammesforfamilymembers,adultsandpeopleintheworkforce.

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Action 7: Conduct reviewon theexistingprovisionof leisure facilities,bookingarrangementsandchargesofvenues

3.18 TheLCSDpledges toprovide,manageandmaintainsafeandhigh-qualityrecreationandsportsfacilitiestofosterpublicparticipationinrecreationalandsportsactivitiesatanaffordablecost. Guidelinesontheprioritiesandquotafor individualandgroupusesare inplacetoenablethevenuemanagementtoprocessapplications for these facilities fromdifferentusers. Inorder tomeettheforeseeable increaseinthepublic’sdemandfor leisurefacilitiesasaresultof theenhancedpublicityof“Sport forAll” innear future, theLCSDplanstoconductareviewontheexistingprovisionofleisurefacilities,bookingarrangementsandchargesofvenuesin2010-14,whichaimstoenableafairallocationoffacilitiesamongdifferentusers.

Priority area 2: Support new and strengthen existing health promotion activities on healthy eating and physical activity participation

(Recommendation2A)Supportnewhealthpromotionprogrammes

3.19 WGDPAagrees thatahealthystart in life is fundamental for thehealthofadult life. WGDPAalsonoted that theworkplacehasbeenrecognisedasan importantsettingforhealthpromotion internationally,suchastheOttawaCharter forHealthPromotionandtheBangkokCharter forHealthPromotioninaGlobalizedWorld.Atpresent,therearelimitedhealthpromotionactivitiesonhealthydietandphysicalactivityparticipation for infantsandyoungchildrenaswellasforpeopleintheworkplace.Toaddresstheissue,WGDPA recommends supporting new health promotion programmes on healthy eating and physical activity participation targeting at young children and their parents, and people in the workplace.Thefollowingparagraphsdetailthehealthpromotionprogrammestobelaunchedintheyearsahead.


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Action 8: DevelopandlaunchanewparentingprogrammeonweaningtargetingallinfantsandyoungchildreninMCHCs

3.20 Weaning is thestageduringwhichababychangesfromapurely fluiddiettoasemi-soliddietwhichcontainsallvarietiesof foodtypicalof thefamily’sdiet. It isan importantstagebecause it influences thedevelopmentof thedietaryhabitsofachild.Hence,theDHwilldevelopandlaunchaparentingprogrammeonweaninginHongKong.Beforerollingoutoftheprogramme,all relevantmedicalandnursingstaffof theDHwillbetrainedin2010.Theimplementationof theprogrammewill takeplace inthethirdquarterof2011withongoingevaluation.

Action 9: DevelopaHongKongCodeofMarketingofBreastmilkSubstitutes

3.21 Breastfeedingprovidesidealnutrientsforthehealthygrowthanddevelopmentofinfants.Theanti-infectivepropertiesofbreastmilkalsohelpprotectinfantsagainstcertaindiseases.Nevertheless,variousfactors/barriersmayinfluencethemothers to feed their infantwithbreastmilksubstitutes,suchas infantformula. In thisconnection, theWHOInternationalCodeofMarketingofBreast-milkSubstituteswasdeveloped in1981 to recommendrestrictionson themarketingofbreastmilk substitutes, toensure thatmothersarenotdiscouraged frombreastfeedingand thatsubstitutesareusedsafely ifneeded.Sincethemarketingofformulamilkiswide-spreadandaggressive,theDHaimstosetupataskforcetodevelopaHongKongCodeofMarketingofBreastmilkSubstitutesby thesecondquarterof2010witha view todevelopingandpromotingtheCodebythefourthquarterof2011.

Action 10: Exploremodelstopromotehealthydietandphysicalactivityinworkplace

3.22 Theworkplaceisanidealsettingforreachingthemajorityofadults.However,whilestudiesinNorthAmericaandEuroperevealedthathealthpromotioninworkplacehavebeeneffective,workplacesaregenerallyunder-utilisedasasetting forpromotinghealthandwell-being inHongKong. To thisend, theDHaimstodevelopandpilotsuitablemodel(s)topromotehealthyeatingandphysicalactivityinworkplaceinHongKongby2010-11.

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Action 11:Expandthe“IdealBMI”DiseasePreventionProject

3.23 The“IdealBMI”DiseasePreventionProject isahealthprogrammelaunchedbytheHAincollaborationwithdifferentcorporatesandorganizationstoraisetheemployees’awarenessofobesityandrelatedhealthproblems,encouragethemtoadopthealthy lifestylesandpromoteacultureofhealthy living fordiseaseprevention. Byyear2010-11, theHAaims toengagearound20businessenterprisesandpublicorganizationsaspartners. Through thisprogramme,employeesmayexperience thebenefitsofhavinghealthierlifestylesandprovisionofhealthyworkingenvironment.Ontheotherhand,theemployersmayalsobenefitfromanimprovementinproductivity,increasestaffmorale,andhelppromotetheircorporateimages.

(Recommendation2B)StrengthentheEatSmartprogrammeoftheDH

3.24 For theexisting territory-widehealthpromotionactivitiesonhealthydietandphysical activity,WGDPA recognises the successof theEatSmartprogrammes(i.e.“[email protected]”Campaignand“[email protected]”Campaign)of theDH in termsof theactiveparticipationofschoolsandrestaurants,andwideacceptancebystudents/parentsandstaff/customers.Buildingon theearly successof thecampaigns,WGDPA recommends strengthening the existing EatSmart programme and broadening its coverage, and may consider extending the EatSmart programme to cover all walks of lifeinfuture.

Action 12: BroadenthecoverageoftheEatSmartSchoolAccreditationScheme

3.25 Schoolsoffer important support for childrenandyoungpeople tomakeinformedchoicesabout theirdietsandprovidethemwithaccesstohealthierfoods.AnidealEatSmartSchoolshouldcontinuouslyimplementadministrativemeasures, provide healthy lunchand snacks, carry out education andpublicity, andshoulder the responsibility of advocatingahealthyeatingenvironmentintheschoolsector.TheEatSmartSchoolAccreditationSchemeorganizedbytheDHin2009aimstomotivateandassistallprimaryschoolsinHongKongto formulateand implementhealthyeatingpolicy,establishafavourable learningenvironment forpromotinghealthyeating,andcultivateandstrengthenthegoodeatinghabitofthestudents.WiththesupportoftheEDB, theAccreditationSchemeisanongoingprojectwhichencouragesthefamily,theschoolandthecommunitytojointlyformulatespecificschoolpolicyandmeasuressothattheschoolwillultimatelyachievethestandardof ‘idealEatSmartschool’.


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(Recommendation2C)Strengthenpubliceducationonnutrition informationonfoodlabelsandenergyimbalance

3.26 Nutrition informationon food labels isan importantpublichealth tool topromoteabalanceddiet,henceenhancingpublichealth. This informationenablesconsumerstocomparenutritionalvaluesofsimilarfoodproductsandthenmakehealthy foodchoices. For thosewhorequirespecialdiets,e.g.peoplewithdiabetesorhighblood lipid,nutrition informationonfood labelsenablesthemtoselectsuitablefoodandhelpmanagetheirhealthconditions.Therefore,WGDPA recommends strengthening the public education on nutrition information on food labels,withaviewtoempoweringmembersofthepublicwiththeabilitytomakehealthyfoodchoices.

3.27 Apart fromstrengtheningpubliceducationonnutrition labelling,WGDPArecognises the importanceofdisseminating informationon thecauseofoverweight/obesityinhealthpromotionprogrammes.Atheart,excessweightiscausedbyenergy imbalance. Eatinghealthier toreduceenergy intakeorbeingmoreactiveto increaseenergyexpenditurealonemaynotbeabletooptimizethebodyweight. Achievingenergybalancethroughhealthyeatingandregularphysicalactivity is thekey tomaintainingoptimalbodyweight.In thisconnection,WGDPA also recommends strengthening the public education on energy imbalance from unhealthy eating and physical inactivity as the cause of overweight/obesity. Besides, importanthealthmessagesshouldbedisseminatedinthecommunitythroughmassmediasothatavery largeaudiencecouldbereachedforraisingthe issuesforpublicattention.

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Action 13: Continuepubliceducationonnutritioninformationonfoodlabels

3.28 Providingnutrition informationon food labelshasbeenrecognisedasoneofthemeanstopromotehealthyeating.ATaskForceonNutritionLabellingEducationcomprisingrepresentativesfromprofessionalorganizations, trade,consumers,academiaandgovernmentdepartmentshasbeen formed tooverseethepublicityandeducationcampaignonnutritionlabelling.Totieinwiththeimplementationofthemandatorynutritionlabellingscheme,theFEHDconductsathree-yearNutritionLabellingPublicityandEducationCampaign,whichaims todrivehometheadvantagesof thenutrition labellingschemeandenhancepublicunderstandingonhowtoreadnutrition labelsandmakeuseofsuch informationtomaintainahealthydiet. Thiscampaign includes,amongothers, theAnnouncementofPublic Interest inTVandradio,releaseof resultsofvariousstudiesonnutrients in food,productionofavarietyofpublicityandeducationalmaterialssuchasthematicvideo,posters,booklets,andsouvenirs,andorganizationofrovingexhibitionsandhealthtalks.

Action 14: ContinuepubliceducationthroughEatSmartprogrammes

3.29 Enablingpeopletomakeinformedchoicesthataffecthealthisimportant.Tothisend, theEatSmartProgrammes(i.e. “[email protected]”Campaignand“[email protected]”Campaign)oftheDHaimtoeducate,empowerandenablethecommunity tohaveeasieraccesstohealthierdiet. Buildingonthesuccessofthesecampaigns,theDHwillcontinueitspubliceducationthrough theEatSmartprogrammes toempowerschoolpersonnel,parents,foodsuppliers,mediaandthepublicwithhealthyeatingtips.

Action 15: Educatepublicontheimportanceandbenefitsofregularparticipationinsportandotherphysicalactivities

3.30 Tomeet thegoalofpromoting the levelofphysicalactivity inHongKong,people’sawarenessandknowledgeofthebenefitsofbeingactiveshouldbeenhancedas thefirststep. In thisconnection, theLCSDplanstoorganizelarge-scalesportspromotionalprogrammeswithaview toeducating thegeneralpublicon the importanceandbenefitsof regularparticipation insportandotherphysicalactivities. Membersof thepublicandcommunitystakeholderswillbeinvitedtojointheseevents.Furthermore,variouspublicitymaterialswillbeproducedanddisseminated through themedia,schools,hospitalsandleisurevenuesoftheLCSD.


35

Priority area 3: Strengthen partnership and foster engagement of all relevant stakeholders

3.31 Thehealthdeterminantsare sopervasive that healthpromotionanddiseaseprevention requireswholecommunity involvementandextendsbeyond thescopeof thehealthsector. Working inpartnershipwithallrelevantstakeholdersat community level is crucial for thesuccessofhealthpromotionwork.Bydrawingpeoplewithdifferentbackgroundsandexpertise, ithelpsmaximisethestrengthsandcreatesynergy. Giventhecomplexityofhumanbehavioursandthechallenges in tacklingunhealthybehaviours,WGDPA recognises the importance thathealthauthority,healthcareprofessionals,governmentdepartmentsandotherNGOstoworkcloselytogetherinamorecoordinatedapproachinordertoaddressthesecomplexissues.

(Recommendation3A)Intra-governmentalpartnership

3.32 Close cooperationwith all government departments responsible forhealth improvementandprotection, food,physicalexercise,environment,transport, employmentand community development canensure thatrelevanthealth-relatedstrategy iseffectively integratedand implemented.In thisconnection,WGDPA recommends government departments/bureaux working together to develop and implement policies that are sensitive to the needs of the public in achieving healthy eating and physical activity participation, and to create an environment, including the built-environment, that facilitate people in making healthier choices.

3.33 Forinstance,provisionofsafeexercisefacilities,walkingpaths,alongwithothertownplanningdesignsthatareconducivetogoodhealth,canincreasetheopportunitiesfor,andreducebarrierstophysicalactivity.Introductionofhealthyeatingpolicyinschoolscanalsohelppromotehealthyeatingatanearlyage.TheDH,LCSDandEDBareworkingcloselytopromotephysicalactivityandhealthyeating inschoolsand/orcommunitysettings. Suchcollaborativenetworkswillstrengthentheplatformtoharnesscommunitysupportandoptimisesynergisticeffect through intersectoralaction. Thefollowingparagraphshighlightourworkplanintheyearstofollow.

36

Action 16:Solicitsupport fromrelevantgovernmentbureauxanddepartments indevelopingandimplementinghealthypublicpolicies

3.34 Commitment and coordinated efforts from government bureaux anddepartmentsarecrucial to facilitatepromotionofhealthydietandphysicalactivityparticipation in thepopulation. In thisconnection,officials fromrelevantbureauxanddepartmentswillbeinvitedtoattendWGDPAmeetingsandbriefmembersregardingtheirworkonpromotionofhealthyeatingandphysicalactivityparticipationin2010.ThiswillalsoenhancecommunicationbetweentheDHandothergovernmentbureauxanddepartmentsregardingtheNCDframeworkandstrategies,andsolicit theirparticipation inbuildinghealthypublicpoliciesinyear2010-11.

Action 17: Solicit support from theEstateManagementAdvisoryCommittees(EMACs)topromotehealthydietandphysicalactivities/healtheducationatestatelevel

3.35 EMACsworkasaneffectivecommunicationchannelbetween theHousingAuthorityandtenantsofpublicrentalhousing(PRH)estates. The leverageandoperationofEMACsalsoserveasausefulplatformforNGOstointroduceawiderangeofservices,includingpromotionofcommunityhealthandfitnesssuchas thepilotneighbourhoodactiveageingproject. Hence, theDHwillworkwiththeHousingDepartment(HD)topromotehealthydietandphysicalactivities/healtheducationat theestate level,e.g.arrangevisits toEMACsto introducetheActionPlan. Moreover,withtherecentendorsementbytheHousingAuthority,EMACscanprovidefundingforNGOs(about$30,000to$50,000perprogramme) to runcommunitybuilding functionsand the likeinPRHestates. NGOsare invited touseEMAC fund toorganizehealthpromotionactivitiesattheestatelevel.


37

(Recommendation3B)Workingwithotherhealthpromotionpartnerstodevelopandimplementpoliciesandpractices

3.36 Furthermore,successfulimplementationofanyhealthpromotionprogrammeswouldnotbepossiblewithout theactivesupportandparticipationof thecommunity. WGDPA recommends other health promotion partners to develop and implement policies and practices that are supportive of healthy eating and physical activity promotion for members of the public.Forexample,HealthyCityandSafeCommunityAssociationssetupindifferentdistrictscanhelpcultivateahealthylivinglifestyleinthecommunitythroughclosecollaborationwiththeGovernment, localorganizationsandthepublic.TheDHcouldalsoexploreopportunitiesintheworkplacetopromotehealthyeatingandphysicalactivityamongtheworkforce.

Action 18: Promulgatetheactionplantootherhealthpromotionpartners

3.37 Changing lifestylehabitsmaybeginat the individualor family level,butmaintaining thedesirablechanges requires thepresenceofaconduciveenvironment for reinforcementat thecommunity level. Healthpromotionprogrammes/policiesneedtofocusonthecommunityasawhole,making itsupportiveandenablingsothatallcommunitymemberscanplayanactiverole inchanging thebehavioural risk factors. Therefore,whendevelopingandimplementinghealthpolicies,participationofcommunityhealthpromotionpartnersisimportantsoastounderstandtheirviewsandsolicittheirsupport.Inthisconnection,theDHmetwithchairmen/representativesofHealthyCitiesProjectsCommittees inDecember2009andwillcontinue toworkwith theHomeAffairsDepartment(HAD)topromulgatetheactionplanatdistrictlevelincludingvarioushealthpromotionpartners.

Action 19:Assisttradetoproducefoodthataresupportiveofhealthyeating

3.38 TheFEHDplans todevelop tradeguidelineson reducingsodium,sugarsandothernutrientsthatexcessiveintakeisnotadvisableinfoodsin2012.Itprovidesguidancetothefoodtradetomodify themanufacturingprocesssoastolowerunhealthycontentsinfoods,whichinturnenablesthecommunitytohaveeasieraccessofhealthier foodcommodities topreventdiet relateddiseaseslikecancers,highbloodpressure,heartdiseasesandstroke.

38

Action 20: Promotehealthylifestyleandself-managementthroughenhancementofprimarycareservices

3.39 Agoodprimary care systemwhichprovides thepublicwith access tocontinuous,comprehensiveandholisticcareisimportantforpromotinghealthandpreventionandcontrolofdiseases. ToenhanceprimarycareservicesinHongKong, theWorkingGrouponPrimaryCare(WGPC)chairedbytheSecretary forFoodandHealthhas formulatedasetof recommendations.Amongst themarestrategiestostrengthenthepreventionandmanagementofNCD,startingwithhypertension (HT)anddiabetesmellitus (DM), thetwocommonestNCD inHongKong. Assetout in the2009-10PolicyAgenda,conceptualmodelsandclinicalprotocols forHTandDMarebeingdevelopedby theWGPCforuseascommonreference to facilitatecross-sectoralcollaborationamongdifferenthealthcareprofessionals inbothpublicandprivatehealthcaresectors. Lifestylemodificationsandenhancedself-management for thepreventionandbetter control of thesemajorNCDareemphasised in theseclinicalprotocols,aswellas in thepilotprojectsunderwaytostrengthenprimarycareservicedelivery.

Action 21:Enlistsupportofstakeholdersinthecommunitytoencourageandsupportphysicalactivity

3.40 TheCSCof theLCSD iscommitted to lowering the ratioof the inactivepopulation,thusachievingtheultimategoalof“SportforAll”inthecommunity.Assuch,theLCSDwilldisseminatethefindingsandrecommendationsoftheStudyof“Sport forAll” tovariousmajorstakeholders in thecommunity,e.g.governmentdepartments,DistrictCouncils,NationalSportsAssociations,DistrictSportsAssociations,businessorganizations,schools,etc., throughletters andother channels. TheLCSDwill also continue to enlist thestakeholders’supporttopromotephysicalactivityparticipationtotheirservicecustomersandstaff.


39

Action 22: Solicitsupporttostrengthentrainingonsportandotherphysicalactivitiesforkindergarten

3.41 Beingphysicallyactiveinchildhoodlaysthefoundationforactiveparticipationinphysicalandsportsactivitiesinadulthood.Thehealthmessageonregularparticipation inphysicalandsportactivitieshavebeendisseminated tostudents,parentsandteachersthroughprimaryandsecondaryschools. Tointegratephysicalandsportactivitiesintoearlychildhood,theLCSDwillworkwiththeEDBfrom2010onwardstostrengthentrainingonphysicalandsportactivities forkindergarten teachersandpre-schoolstudentsbyorganizingworkshopstoenhancetheirknowledgeinthisaspect.

Priority area 4: Build the capacity and capability to promote healthy eating and physical activity participation

(Recommendation4A)Reviewoverseasand local literatureonhealthpromotioninterventions

3.42 Fromthepublichealthperspective,healthpromotionisanimportantstrategyinprimarypreventiontoimprovethehealthofthepopulationasawhole.Ashealthbehavioursareintricatelyconnectedwiththelivingenvironmentinmanyways,healthpromotionneedstobeevidence-basedandoutcome-focused.Conventionalmeansofhealth informationdisseminationsingly throughdistributionofhealtheducationmaterialsandorganizingpublicitycampaignsarenotaseffectiveasonewouldhavethought.Inplanninghealthpromotionprogrammes,organizersshouldtakereferencefromeffectivehealthpromotionintervention,andshouldconsider factors thatwillenhancethesustainabilityofeffectiveprogrammes.Thus,WGDPA recommends reviewing overseas and local literature of health promotion interventions on healthy eating and physical activity participation, so as to identify elements of success and factors which enhance programme sustainability.

40

Action 23: Review,summariseandcommunicate findingswithstakeholdersonregularbasis

3.43 TheDHiscommittedtobuildingtheevidencebasefortheeffectivenessandcost-effectivenessofpublichealth interventions, including thoserelated todietandphysicalactivity.TheDHhasbeenconductingongoingreviewsandsummarising important findings fromevidence-based literatures,aiming todevelopevidence-baseddata forsharingwithhealthpromotionpartnersonregularbasisusingthematicwebsitesinyear2010-11soastoleadactiontoimprovethehealthofthepeopleinHongKong.OtherserviceunitsintheDHwillalsoconductongoingreviewsrelated tootherareasof interestandwillcommunicateusefuldata/information tohealthpromotionpartners throughvariousmeans.

(Recommendation4B)Organize forumsandworkshops for fosteringpartnerships,bettercoordinationofeffortsandcapacitybuilding

3.44 Itisimportanttoempowerthepartnersandstakeholderswiththeknowledgeandskills inaddressingtheproblemsofunhealthydietaryhabitandphysicalinactivity. In thisconnection,WGDPArecommendsorganizing forumsandworkshops for fosteringpartnerships,better coordinationofeffortsandcapacitybuildingamonghealthpromotionpartners. TheDHhasorganizedcapacity buildingprogrammes for its staff andNGOs toenhance theirknowledgeandskills inhealthpromotion. Basichealthpromotionconceptsand theoriesaswellasgoodpracticesareshared in thesesettings. Moretrainingopportunitiesshouldbeconsideredtoequiphealthpromotionpartnersin thecommunitywith theskills inorganizingeffectiveandevidence-basedhealthpromotionprogrammestocomplementgovernment’srole.

Action 24:OrganizeaconferenceonNCDprevention

3.45 InordertoeffectivelyraisetheawarenessofNCDpreventionandcontrolandbringabout thesynergistichealthbenefitsofmodifyingmajorbehaviouralriskfactors, theDHplanstohostaconferenceinearly2012,puttingspecialemphasisonthepromotionofhealthydietandphysicalactivity,preventionofalcoholmisuseandinjuries,aswellascommunityparticipationandcapacitybuilding.Throughthisevent,weaimtobringtogethermajorlocalaswellasinternationalhealthpromotionpartnerstosharetheirexperienceonsuccessfulhealthpromotionapproachesandbestpractices.


41

Action 25:Identifyhealthpromotionagenciesthroughvariousforums

3.46 Successful communityprojectsacknowledgeand involve thegroupsorindividualswhohaveastake in the issue. Isolatedactionwillonlybringlimitedimpact,andapartnershipapproachisdesirableatthecommunitylevel.In thisconnection, theDHwillorganizedifferent forums inyear2010-12toidentifyasmanyhealthpromotionagenciesaspossible,andengagethemforcollaborationinfutureinrelationtopromotinghealthydietandphysicalactivityparticipation inHongKong. Buildingcoalitionsandpotentialpartnershipamong thestakeholderscan furtherchampion theeffort inpromoting thehealthofourcitizensinHongKong.

Action 26:Developeducationkitsonbreastfeeding forhealthprofessionalsandorganizeworkshops

3.47 Good nutrition in early years of life is amajor determinant of growthanddevelopmentandwilldirectly influence thehealth inadulthood. Asbreastfeedingprovidesclearshortand long termhealthbenefits forbothinfantsandmothers,breastfeeding isrecommendedasthebestnutritionforinfantsinthefirstsixmonthsoflife.Inviewofthelowexclusivebreastfeedingrate inHongKong,WGDPAurgeshealthprofessionals tosupportwomeninchoosingbreastfeeding for their infants. TheDHthusplans todevelopaneducationkitonbreastfeeding forhealthprofessionalsandorganizeworkshops to teach themthenecessaryskills tosupportandempower themothersandtheirfamiliestoachievetheirbreastfeedinggoals.Theeducationkitswillbe launchedinthesecondquarterof2010whiletrainingworkshopswillbeorganizedin2011.

(Recommendation4C)Applytheories,concepts,evidenceandskillsinplanningandorganizationofactivities

3.48 Inadditiontoappraisingevidenceonsuccessfulelementsforhealthpromotionprogrammes, it isalso important to incorporate thesesuccess factors intotheprogrammes. Likewise,elementsdemonstrated tobenoteffectiveshouldnotbe introducedagain,henceavoidingreinventingthewheel. Thisisanessentialway toachievebetteroutcomegiven limited resources.Therefore,WGDPA recommends the health promotion agencies to apply health promotion theories, concepts, evidence and skills in planning and organization of healthy eating and physical activity promotional activities, which could take the form of ‘demonstration projects’.

42

Action 27: Arrangetrainingworkshopsforhealthpromotionpartnerstobuilduptheirskillsonorganizinghealthpromotionprogrammes

3.49 Puttingresearch findings intopractice is importantwhenorganizinghealthpromotionprogrammes. Toequip thehealthpromotionpartnerswith thenecessary knowledgeandskills in applyinghealthpromotion theories,concepts and evidence in planning and organizing health promotionprogrammes, theDHwillarrangeat least four trainingworkshopsfor thesetargetaudienceinyear2010-12.

Priority area 5: Secure resources for health promotion on healthy eating and physical activity participation

(Recommendation5A)Sharethevisionandplanswithstakeholdersandcommunitymembers

3.50 WGDPAbelieves that the small-scaleand short-termhealthpromotionactivitiesmaynotgeneratesignificantimpactonimprovingpopulationhealth.Resourcesshouldbepooled together tobetterutilise the fundingavailableaswellas tomaximise the impactofhealthpromotionactivities. In thisregard,WGDPA recommends the Government to share the vision and plans of the Strategic Framework for NCD Prevention and Control with stakeholders and community members.

Action 28: Organize forumforhealthpromotionpartners topromulgate theNCDStrategicFrameworkandtheActionPlan

3.51 WGDPA recognises that in order tomake healthier choices easier,interdepartmentalcollaborationandpartnershipwithkeystakeholdersandcommunitysectorsareofvitalimportance.Thus,theDHwillorganizeatleastfourforums/workshopsinyear2010-12fordifferenthealthpromotionpartnerstopromulgatetheStrategicFrameworkforNCDPreventionandControlandtheActionPlan,aimingtoenlisttheirsupportforactivitiesandpoliciesthatwillcontributedirectlyandindirectlytothepromotionofhealthofthepopulation.


43

(Recommendation5B)Applicationsforfunds

3.52 NGOs and academic institutions should also be encouraged to submit applications for funds provided by the Administration and other sources to conduct research studies relating to health promotion. SuchfundingsourcesincludetheHealthCareandPromotionFund,theHealthandHealthServicesResearchFund,ResearchGrantsCouncilof theUniversityGrantsCommittee, theCommunity InvestmentandInclusionFund, theHongKongJockeyClubCharitiesTrust,theSKYEEMedicalFoundation,andtheBoardofManagementoftheChinesePermanentCemeteries,etc.

Action 29: ConductworkshopsforNGOstoenhancetheirunderstandingofvariousfundingsourcesandapplications

3.53 InHongKong, fundingsourcesareavailable forvarious research/projectthemes, includinghealthpromotion initiatives. However,many fundingsourcesmay impose various requirements, and understanding suchrequirements is fundamental forNGOstosecuremoreresourcesforhealthpromotionprogrammesonhealthydietandphysicalactivityparticipation. Inthisconnection, theDHplanstoorganizeat least four forums/workshops inyear2010-12forNGOsandotherhealthpromotionpartnerstoenhancetheirunderstandingonvariousfundingsourcesandapplications.

(Recommendation5C)Encouragehealthpromotionpartners toexplore innovativemeansoffunding

3.54 It is important to findwaystomobilize local resources topromotehealth inthecommunitythroughbuildingpartnershipbetweenpublic,privateandnon-governmentalorganizations. In this regard,WGDPAencourageshealthpromotionpartnerstoexploreinnovativemeansoffundingsuchascharitabletrusts(setupbybusinesscorporationswithemphasisonsocialresponsibility),matchingfundsandseedinggrants.

44

Action 30: Explore thepossibilityofsecuringdifferentsourcesof funding fromestablishedchannelstopromotehealthyeatingandphysicalactivity

3.55 WGDPArecognises thatdiversifiedsourcesof funding forhealthpromotioncanattract theparticipationofcommunitypartnersandNGOs inpromotinghealthyeatingandphysicalactivityparticipation. Thus,various fundingsources, including innovativemeansof fundingsuchascharitable trusts,matchingfundsandseedinggrants,wouldbeexploredregularlywithaviewtopoolingtogetherexistingresourcesfromdifferentchannelsforbetterutilisationandtocreatesynergy.


45

Tabl

e 1

Lis

t of d

etai

led

actio

ns w

ith ta

rget

s an

d tim

efra

me

Prio

rity

Are

asR

ecom

men

datio

ns A

ctio

nsLe

ad a

ctio

n pa

rty

Targ

et(s

)/Ind

icat

or(s

)Ti

mef

ram

e

fective

ef and

habit

an

Generate base

dietary

on

physicalactivity

guide

to

1) information

system

and

participation

actions

surveillance

factor

risk

changes

dietary and

Strengthen track

NCDand unhealthy

of physicalinactivity the

of

behavioural

(1A

) the

of in profile

habit,

overweight/obesity

population.

,

Surveillance

obesity

outh-Health factors,

for

identify

risk

those school

to [Act

ion

1]

YBehaviour

Pilot

System

behavioural

including

secondary

in students

•DH

EDB

• •

study

the

Com

plete

Q22010

by Com

pletethereview

Q42010

by

• •

2010

of

grow

th

in

of

use

the

Explore

parametermeasured

trackchanges

to

schools [A

ctio

n 2]

obesity

••

EDB

•DH

•Developlogistics

tomonitorthe

prevalenceofobesity

inschoolchildren

2010

46

Prio

rity

Are

asR

ecom

men

datio

ns A

ctio

nsLe

ad a

ctio

n pa

rty

Targ

et(s

)/Ind

icat

or(s

)Ti

mef

ram

e

•ConductTotalDietS

tudyto

assessthedietaryintakeof

thepopulation

[Act

ion

3]•

FEHD

•Reviewthefindings

oftheFood

ConsumptionSurvey

in2010

•Conductfieldw

orkof

TotalD

ietS

tudyin

2010-2011

•Publishreportsof

TotalD

ietS

tudyin

phasesfrom

2011to

2014

2010-14

(1B

)Conductpopulation-

basedhealthsurveys

withbiomedicalriskfactor

measurementregularlyto

monitorthehealthprofileof

thepopulationwithreference

toW

HO’s‘STE

PS’.

•Conductthesecond

PopulationHealthSurvey

foradultsaged15or

abovewithbiochem

ical

measurementse.g.

anthropometric

measurements,blood

glucoseandbloodlipid

profiles

[Act

ion

4]

•DH

•Academia

•Com

missionthe

studyin2011

•Conductpilotstudy

in2012

•Conductfieldw

orkin

2013/14

•Publishthereportin

2014/15

2011-15


47

Prio

rity

Are

asR

ecom

men

datio

nsA

ctio

nsLe

ad a

ctio

n pa

rty

Targ

et(s

)/Ind

icat

or(s

) T

imef

ram

e

(1C

)Promoteandsupport

researchinareasrelatedto

thebehaviouralriskfactor

modificationandtheeffective

interventionsinpromoting

healthyeatingandphysical

activityparticipation,e.g.

researchonparental

know

ledge,attitudeand

practiceoffeedinginfants

andyoungchildren,

includingbreastfeedingand

weaning;foodandnutrient

intakesofinfantsandyoung

children.

•Conductasurveyon

parentalknowledge,

attitudeandpracticeof

feedinginfantsandyoung

children(6-month-oldto

2-year-oldand4-year-old)

•Conductasurveyonmilk

consum

ptionofinfantsand

youngchildren(12-month-

oldto2-year-oldand

4-year-old)

•Conductadietarysurvey

oninfantsandyoung

children(6-month-oldto

2-year-oldand4-year-old)

•Conductasurveyon

physicalactivityofyoung

children(2-year-oldand

4-year-old)

[Act

ion

5]

•DH

•Academia

•Com

pletedata

collection&analysis

byendofD

ecem

ber

2010

•Publishreportby

March2011

2010-11

48

Prio

rity

Are

asR

ecom

men

datio

nsA

ctio

nsLe

ad a

ctio

n pa

rty

Targ

et(s

)/Ind

icat

or(s

)Ti

mef

ram

e

•Conductreview

onthe

existingprovisionof

recreationandsports

programmessoasto

providemoreattractive

programmesforfam

ily

mem

bers,adultandpeople

intheworkforce

[Act

ion

6]

•LC

SD

•Toenhancethe

programmemix

andtodesignsome

newprogram

mes

cateringfortheneed

ofdifferenttargets

2010-14

•Conductreview

onthe

existingprovisionof

leisurefacilities,booking

arrangem

entsandcharges

ofvenues,etc.tocopewith

theprom

otionofsportfor

all [

Act

ion

7]

•LC

SD

•Toenhancethe

provisionofleisure

facilities

2010-14

2)Supportnewand

strengthenexistinghea

prom

otionactivities

onhealthyeating

andphysicalactivity

participation

(2A

)Providesupportfor

lthnew

healthpromotion

programmesonhealthy

eatingandphysicalactivity

participationtargetingyoung

childrenandtheirparents,

andpeopleinworkplace.

•Developandlauncha

newparentingprogramme

onweaningtargetingall

infantsandyoungchildren

(6-month-oldto2-year-

old)inMaternalandChild

HealthCentres

[Act

ion

8]

•DH

•Trainrelevant

medical&nursing

staffofD

Hin2010

•Implem

entthe

programmeinQ3

2011

•Ongoingevaluation

oftheprogramme

2010-12


49

Prio

rity

Are

asR

ecom

men

datio

nsA

ctio

nsLe

ad a

ctio

npa

rty

Ta

rget

(s)/I

ndic

ator

(s)

Tim

efra

me

•DevelopaHongKong

CodeofMarketingof

BreastmilkSubstitutes

[Act

ion

9]

•DH

•Setupataskforce

byQ22010

•Codedevelopedby

Q42011

2010-11

•Exploremodelstopromote

healthydietandphysical

activityinworkplace

[Act

ion

10]

•DH

•Developsuitable

model(s)tobe

consideredforpilot

testing

2010-11

•Expandtheworkplace

healthpromotion

programme,nam

ely

“IdealBMI”Disease

PreventionProject,w

hich

aimstoim

provehealthat

individualandorganization

levelsincollaboration

withcom

munitypartners

[Act

ion

11]

•HA

•Engagearound20

commercialand

publicorganizations

tojointheproject

andencourage/

supportthe

organizationsto

provideasupportive

environm

entforthe

healthoftheirstaff

2010-11

(2B

)Strengthenthe

EatSmartprogram

meofDH

andbroadenitscoverage

inschoolsandconsider

extendingtheprogrammeto

othersettings.

•Broadenthecoverage

oftheEatSmartS

chool

AccreditationSchem

e

[Act

ion

12]

•DH

•EDB

•Engageallprim

ary

schools

2010-15

50

Prio

rity

Are

asR

ecom

men

datio

nsA

ctio

nsLe

ad a

ctio

n pa

rty

Targ

et(s

)/Ind

icat

or(s

) T

imef

ram

e

(2C

)Strengthenpublic

educationonnutrition

informationonfoodlabels

andenergyim

balanceasthe

causeofoverweight/obesity.

•Continuepubliceducation

onnutritioninformationon

foodlabels[A

ctio

n 13

]

•FE

HD

•Conducta3-year

NutritionLabelling

Publicityand

EducationCam

paign

with3phases

2010-12

•Continuepubliceducation

throughEatSmart

programmes

[Act

ion

14]

•DH

•EDB

•Empowerschool

personnel,parents,

foodsuppliers,m

edia

andthepublicwith

healthyeatingtips

Ongoing

•Educatepubliconthe

importanceandbenefits

ofregularparticipationin

sportandotherphysical

activities[A

ctio

n 15

]

•LC

SD

•Organizelarge-scale

sportspromotional

programmesand

invitepublicand

stakeholderstojoin

•Producevarious

publicitymaterials,

suchasDVDand

broadcastthroughTV,

Roadshow,schools,

hospitalsandleisure

venuesofLCSD

2010


51

Prio

rity

Are

asR

ecom

men

datio

nsA

ctio

nsLe

ad a

ctio

n pa

rty

Targ

et(s

)/Ind

icat

or(s

) T

imef

ram

e

3)Strengthenpartnership

andfosterengagem

entof

allrelevantstakeholders

(3A

)Governm

ent

departm

ents/bureauxwork

togethertodevelopand

implem

entpoliciesthatare

sensitivetotheneedsofthe

publicinachievinghealthy

eatingandphysicalactivity

participation,andcreate

anenvironm

ent,including

thebuilt-environm

ent,that

facilitatepeopleinmaking

healthierchoices,e.g.

provideaccesstosafe

exercisefacilities,walking

paths,alongwithothertown

planningdesignsthatare

conducivetogoodhealth;

introducehealthyeating

policyinschools,etc.

•So

licitsupportfromrelevant

governmentbureauxand

departm

entsindeveloping

andimplem

entinghealthy

publicpolicies

[Act

ion

16]

•

WGDPA

•DH

•Inviterelevant

bureauxand

departm

entstobrief

WGDPA

mem

bers

andintroducetheir

workonpromotion

ofhealthyeating

andphysicalactivity

participation

2010-11

52

Prio

rity

Are

asR

ecom

men

datio

nsA

ctio

nsLe

ad a

ctio

n pa

rty

Targ

et(s

)/Ind

icat

or(s

) T

imef

ram

e

•SolicitsupportfromEMACs

topromotehealthydietand

physicalactivities/health

educationatestatelevel

[Act

ion

17]

•DH

•HD

•Arrangevisitsto

EMACstopromote

healthydietand

physicalactivities/

healtheducation

•InviteNGOstouse

EMACfundfor

organizinghealth

education/prom

otion

activitiesatestate

level

2010-11

(3B

)Otherhealthpromotion

partnerstodevelopand

implem

entpoliciesand

practicesthataresupportive

ofhealthyeatingand

physicalactivitypromotion

form

embersofthepublic.

•PromulgatetheActionPlan

tootherhealthpromotion

partners,e.g.through

meetingwithHealthyCities

Projects[A

ctio

n 18

]

•DH

•HAD

•Briefm

embersof

theHealthyCities

ProjectsCom

mittees

in18districtsonthe

ActionPlan

2010

•Assisttradetoproduce

foodthataresupportiveof

healthyeating

[Act

ion

19]

•FE

HD

•Developtrade

guidelineson

reducingsodium,

sugarsandother

nutrientsthat

excessiveintakeis

notadvisableinfoods

2012


53

Prio

rity

Are

asR

ecom

men

datio

nsA

ctio

nsLe

ad a

ctio

n pa

rty

Targ

et(s

)/Ind

icat

or(s

)Ti

mef

ram

e

•Promotehealthylifestyle

andself-managem

ent

throughenhancem

ent

ofprim

arycareservices

[Act

ion

20]

•DH

•Consultandliaise

withhealthcare

professionals

2010

•Enlistsupportof

stakeholdersinthe

community,suchas

DistrictCouncils,N

ational

SportsAssociations,

schools,corporations,etc.

[Act

ion

21]

•LC

SD

•Letterstovarious

stakeholdersto

introducethe

findingsand

recommendationof

the"StudyofS

port

forA

ll"•

Enlisttheirsupport

topromotephysical

activityparticipation

totheirservice

custom

ersandstaff

2010

•So

licitsupporttostrengthen

theirtrainingonsportand

otherphysicalactivitiesfor

kindergarten

[Act

ion

22]

•LC

SD

•EDB

•Providetrainingplan

forkindergarten

teachersandpre-

schoolstudents

2010

onwards

54

Prio

rity

Are

asR

ecom

men

datio

nsA

ctio

nsLe

ad a

ctio

n pa

rty

Targ

et(s

)/Ind

icat

or(s

)Ti

mef

ram

e

4)Buildthecapacity

andcapabilityto

prom

otehealthyeating

andphysicalactivity

participation

(4A

) Reviewoverseasand

localliteratureofhealth

prom

otioninterventionson


activityparticipationto

identifyelem

entsofsuccess

andfactorswhichenhance

programmesustainability.

•Review,sum

mariseand

communicatefindingswith

stakeholdersonregular

basis

[Act

ion

23]

•DH

•Developevidence-

baseddatafor

sharingwithhealth

prom

otionpartners

onthem

aticwebsites

•Com

municateuseful

data/information

throughvarious

means

2010-11

Ongoing

(4B

)Organizeforumsand

workshopsforfostering

partnerships,better

coordinationofeffortsand

capacitybuildingam

ong

healthpromotionpartners.

•Organizeaconference

onNCDprevention

emphasisingonpromotion

ofhealthydietandphysical

activity,preventionof

alcoholm

isuseandinjuries,

aswellascommunity

participationandcapacity

building

[Act

ion

24]

•DH

•Involvemajorkey

healthpromotion

agenciesinthe

conference

Early2012

•Identifyhealthpromotion

agenciesthroughvarious

forums

[Act

ion

25]

•DH

•Identifyasmanykey

healthpromotion

agenciesaspossible

forcollaboration

2010-12


55

Prio

rity

Are

asR

ecom

men

datio

nsA

ctio

nsLe

ad a

ctio

n pa

rty

Targ

et(s

)/Ind

icat

or(s

) T

imef

ram

e

•Developeducationkitson

breastfeedingforhealth

professionalsandorganize

workshops[A

ctio

n 26

]

•DH

•Launcheducation

kitsinQ22010

•Organizeworkshops

in2011

2010-11

(4C

)Healthpromotion

agenciestoapplyhealth

prom

otiontheories,

concepts,evidenceandskills

inplanningandorganization

ofhealthyeatingand

physicalactivitypromotional

activitieswhichcouldtake

theformof‘demonstration

projects’.

•Arrangetrainingworkshops

forhealthpromotion

partnerstobuilduptheir

skillsonorganizinghealth

prom

otionprogrammes

[Act

ion

27]

•

DH

•Organizeatleast

fourforums/

workshops

2010-12

56

Prio

rity

Are

asR

ecom

men

datio

nsA

ctio

nsLe

ad a

ctio

n pa

rty

Targ

et(s

)/Ind

icat

or(s

)Ti

mef

ram

e

5)Secureresources

forhealthpromotion

onhealthyeating

andphysicalactivity

participation

(5A

)Sharethevisionand

plansoftheStrategic

Fram

eworkforN

CD

PreventionandControlw

ith

stakeholdersandcom

munity

mem

bers.

•Organizeforumforhealth

prom

otionpartnersto

prom

ulgatetheNCD

StrategicFram

eworkand

theActionPlantoPromote

HealthyDietandPhysical

ActivityParticipationin

HongKong

[Act

ion

28]

•DH

•Organizeatleast

fourforums/

workshops

2010-12

(5B

) EncourageNGOs

andacadem

icinstitutions

tosubmitapplications

forfundsprovidedbythe

Adm

inistrationandother

sourcestoconductresearch

studiesrelatingtohealth

prom

otion.

•Conductworkshopsfor

NGOstoenhancetheir

understandingonvarious

fundingsourcesand

applications[A

ctio

n 29

]

•DH

•Organizeatleast

fourforums/

workshops

2010-12

(5C

) Encouragehealth

prom

otionpartnersto

exploreinnovativemeansof

fund

ing.

•Explorethepossibilityof

securingdifferentsources

offundingfromestablished

channelstopromote


activity

[Act

ion

30]

•DH

•Topooltogether

existingresources

fromdifferent

channelsforbetter

utilisationandto

createsynergy

Ongoing

4.Makingithappen

57

Making it happen 4

58

44.1 Totakeforththeproposedintersectoralcollaborationasrecommendedinthis

ActionPlan,consultationwithlocalNGOsandothercommunitystakeholderswillbeconducted toseek theirviewson theactionsand their interests toparticipate. Inorder toensurethatpeople inallpartsof thesocietywillgetinvolvedandact together, the implementationof theActionPlanwill bepublicisedthroughvariousmeans.

4.2 ThecurrentNCDchallengeHongKong faces isgreater thanpreviouslyrealised. Intheactual implementationof theActionPlantopromotehealthydiet and physical activity participation inHongKong, there aremanyforeseeablebarriersthatneedtobeovercomeinordertoachievethevisionandgoalassetout in theNCDpreventionandcontrolstrategy. Moreover,WGDPArecognisesthattheactiveparticipationbyeveryoneinthecommunityisthekeytosuccess.

4.3 Witha leadershiprole incombatingthechallengeofNCD, theGovernmentcouldprovide thepeoplewith informationonnutritionandphysicalactivitypertainingtohealthyliving,andworkcloselywiththestakeholdersinboththepublicandprivatesectors tocreateasupportiveenvironment forpeople tomaketherightchoicesforthemselvesandtheirfamilies.Itistimetocallforindividualsinthesocietytotaketheirownresponsibilityfortheirhealth,andtomaketheirownchoicesofhealthbehaviours.Relevantstakeholdersalsoplayanimportantrole inhealthpromotionactivities, forexample, foodindustrytosupplyhealthierchoicesoffood,andemployerstoprovideahealthyworkingenvironmentfortheirstaff.

4.4 ItistimeforeveryoneinthecommunitytoacttogetherincombatingtheNCDbattle.Byworkinginpartnership,everyonecanmakeHongKongahealthierplacetolive.

Annexes

59

Annexes

60

Annex1Membership of Working Group on Diet and Physical Activity

ChairmanProfAlfredCHANCheung-ming,BBS,JP

ViceChairman DrLAMPing-yan,JP Members ProfJulianaCHANChung-ngor MrCHAUHow-chen,GBS,JP DrCHEUNGWai-lun,JP MrMichaelLAIKam-cheung,MH,JP MsCatherineLEEOi-wa DrLoboLOUIEHung-tak MrJamesNGChi-ming DrMarySCHOOLING MrTANGKwai-tai DrJoyceTANGShao-fen DrTSEHung-hing MrWONGKa-wo,JP DrWONGMan-sau Ex-officioMembers MsOliviaCHANYeuk-oi MrTonyLIUKing-leung DrThomasTSANGHo-fai,JP MrBenjaminYUNGPo-shu

Secretary DrLEUNGTing-hung,JP

Annexes

61

Annex2Terms of reference of Working Group on Diet and Physical Activity

(a) Toassesstheepidemiology,riskfactorsandsocioeconomicdeterminantsofspecificNCDwithreferencetodietandphysicalactivityoflocalpopulation;

(b) Tomakerecommendationsonthehealthandhealth improvementneedsofthelocalpopulationinrelationtohealthydietandphysicalactivity;

(c) Toreviewlocalandinternationalgoodpracticesandinterventionstrategiestopromotehealthydietandphysicalactivity;and

(d) Tomake recommendations on the development, implementation andevaluationofaplanofactionforpromotionofhealthydietandphysicalactivityinHongKong.

62

Annex3D

iscu

ssio

n to

pics

of W

orki

ng G

roup

on

Die

t and

Phy

sica

l Act

ivity

mee

tings

Dat

eTo

pics

FirstM

eeting

16Decem

ber2008

•HighlightsoftheStrategicFram

eworkforP

reventionandControlofN

on-Com

municable

Diseases

• •Diet,PhysicalActivityandHealth:H

ongKongSituation(W

GDPA

PaperNo.01/2008)

HealthPromotionProgram

mesbytheDepartmentofH

ealth(W

GDPA

PaperNo.

02/2008)

SecondMeeting

23February2009

• • •

Environm

entalScanningofInformation,ResearchandHealthPromotionActivityon

DietandPhysicalActivityinHongKong(W

GDPA

PaperNo.01/2009)

HealthPromotion:ConceptsandPractice(W

GDPA

PaperNo.02/2009)

PresentationonHealthandHealthServicesResearchFundandHealthCareand

PromotionFund

ThirdMeeting

27April2009

•DiscussiononthedraftR

eporton

andPhysicalActivityParticipationRecom

mended

inHongKong

ActionstoPromoteHealthyEating

FourthMeeting

9Novem

ber2009

•DiscussiononthedraftA

ction

ParticipationinHongKong

PlantoPromoteHealthyEatingandPhysicalActivity

Annexes

63

Annex4Su

mm

ary

of M

embe

rs’ i

nput

on

loca

l hea

lth p

rom

otio

n ac

tiviti

es

(The

title

s of

som

e pr

ogra

mm

es a

re in

Chi

nese

onl

y)

Org

aniz

atio

nD

iet

Phys

ical

act

ivity

Hea

lthy

lifes

tyle

Infa

nt a

nd y

oung

chi

ldre

nPlayrightChildren’sPlay

Association

•Outreachservices,playsafety

inspectionservice

HongKongChildhealth

Foundation

•Pre-schoolM

otor

PerformanceAwardSchem

eCentreforH

ealthEducationand

HealthPromotionoftheCUHK

•HealthySchools(P

re-School)

AwardSchem

eWatchdogEarlyLearningand

DevelopmentC

entre

•InnovationsinHealthand

Wellness:aFitnessand

NutritionProgram

ForSpecial

NeedsChildrenproject

Scho

ol c

hild

ren

and

adol

esce

ntTheCUHK

•HealthyUniversity

Program

mes


Program

mes


Program

mes

HongKongCouncilofEarly

ChildhoodEducation&Services

•BuildingHealthyTuckShop–

HealthyPrim

arySchoolTuck

ShopProgram

YangMem

orialM

ethodistSocial

ServiceShatinIntegratedCentre

forYouthDevelopment

•Healthyeatingclassessuch

as 親

子美

食DIY

64

Org

aniz

atio

nD

iet

Phys

ical

act

ivity

Hea

lthy

lifes

tyle

UnitedChristianNethersole

Com

munityHealthService

•Healthyeatingeventssuch

as“B

reakfastClub”,“Healthy

SnackW

orkshop”

•Com

munitynutrition

placem

entandcareertalkfor

tertiarystudents

•SchoolandHom

eInvolvem

ent,Nutrition

andExercise(SHINE)

programmeforhealthy

lifestyleproject

•HealthPromotingSchool

Project

EducationBureau

•OutdoorEducationCam

p

EducationBureau&HongKong

SchoolsDanceAssociation

•SchoolsDanceFestival

EducationBureau,HongKong

ChildhealthFoundation,Physical

FitnessAssociationofHong

Kong,China

•SchoolPhysicalFitness

AwardSchem

e

LeisureandCulturalServices

DepartmentandEducation

Bureau

•SchoolSportsProgram

me

A.S.W

atsonGroup

•A.S.W

atsonGroupHong

KongStudentSportsAwards

HongKo

ngCollegeofC

ardiology

•JumpRopeforH

eartProgram

HongKongSchoolsSports

Federations

•Inter-school,inter-district,

inter-portandinternational

studentsportscom

petitions

Annexes

65

Org

aniz

atio

nD

iet

Phys

ical

act

ivity

Hea

lthy

lifes

tyle

TheBoys’&Girls’Clubs

AssociationofHongKong,

Departmentofpaediatricsand

adolescentmedicineofthe

UnitedChristianHospital

•IntegratedandSustainable

Com

munityPioneerProject

forO

besechildren

CentreforH

ealthEducationand

HealthPromotionoftheCUHK

•HongKongHealthySchools

AwardSchem

e•

“Hom

e-SchoolJointVentureto

Com

batC

hildhoodObesity”

HavenofH

opeChristianService

• 「

真」

健美

大行

動–

身心

健康

區

校推

廣教

育計

劃

HongKongEvangelicalChurch

BradburySheungShuiFam

ily

Center

• 「

健康

活力

小種

子」

計劃

HongKongPlaygroundAssociation

• 「

健康

新營

人」

計劃

Pam

elaYoudeNethersoleEastern

HospitalandtheHongKongCenter

forH

ealthPromotionandDisease

PreventionoftheHongKong

Tuberculosis,C

hestandHeart

DiseasesAssociation

•SchoolH

ealthPromotion,Hong

KongEastC

lusterproject

66

Org

aniz

atio

nD

iet

Phys

ical

act

ivity

Hea

lthy

lifes

tyle

TheSalvationArmyYaum

atei

I ntegratedServiceForYoungPeople

•Ed

ucateyoungpeopleonreading

nutritionallabel,promotehealthy

eatingandactiveliving

St.James’Settlement

• 「

叻營

仔女

全攻

略」

計劃

Adu

ltHongKongNutritionAssociation

•Ea

tSmartforTotalHealthRecipe

Design&CookingCom

petition


Com

munityHealthService

•Foodlabellingandfuncooking

class

•Com

munityNutritionService

•Healthycookingclasses

•WeightM

anagem

entC

lasses

•Healthpromotionprogrammefor

professionaldriversandSouth

Asiancom

munity

DepartmentofO

rthopaedicsand

TraumatologyoftheCUHKandthe

FamilyPlanningAssociationofHong

Kong

•Post-m

enopausalw

omenwalk

towardsahealthylife

Caritas–HongKong

•PromotionofW

ellnessin

WorkplacewithanEast-M

eet-

WestApproach

CareForY

ourH

eart

•Eathealthyandgetactive:a

lifestyletostartandkeep!

Annexes

67

Org

aniz

atio

nD

iet

Phys

ical

act

ivity

Hea

lthy

lifes

tyle

Elde

rly


Com

munityHealthService

•OutreachNutritionConsultation

Servicesforelderlycentres

•TaiC

hiclasses

CastlePeakHospital

•LifeStyleRedesignProgram

Who

le c

omm

unity

AssociationofGreenOrganic@

Living

•Cookingclasses

•Healthfoodrecipes

•Healthsem

inars

HealthyCitiesProjectsinvarious

districts

•Healthpromotionevents




Com

munityHealthService

•Publicnutritioneducationvia

magazine 「

健康

動力

」

•Healthtalks

•Regularmediainterview

•TaiC

hiandfolkdanceclasses

forpatientswithchronic

diseasesthrough“Good

NeighbourNetwork”

•

SchoolandHom

eInvolvem

ent,Nutritionand

Exercise(SHINE)@

the

community

•Masscommunityhealth

prom

otionevents

LeisureandCulturalServices

Department

•HealthyExerciseforA

llCam

paign

DistrictSportsAssociationof

Hom

eAffairsDepartment

•Organizerecreationand

sportsactivitiesatdistrictlevel

HongKongMedicalAssociation

•Healthy8,000Steps

Cam

paign

•ExercisePrescriptionProject

NationalSportsAssociation

•Organizesportstraining

programmes

68

Org

aniz

atio

nD

iet

Phys

ical

act

ivity

Hea

lthy

lifes

tyle

HealthInfoWorldoftheHospital

Authority

•“BetterH

ealthforaBetter

HongKong”healthpromotion

campaign

•“IdealBMI”Disease

PreventionProject

AberdeenKai-fongW

elfare

Association

• 「

運動

保方

- 糖

尿篇

」計

劃

HongKongEvangelicalChurch

BradburySheungShuiFam

ily

Center

• 「

健樂

每一

步」

計劃

HongKongRedCross

• 「

五星

健康

五星

家」

之「

健

康生

活模

式」

推廣

HKSKHLadyMacLehoseCentre

• 「

營養

身心

，健

康人

生」

計劃

Annexes

69

Annex5Health promotion: concepts and practice

1. Applicationof ‘healthpromotion’ to improvepopulationhealthdatedbackto itsembryonicbeginnings in the latesixtieswhichblossomed intoaninternationaldiscipline in theeighties. At the firstGlobalConferenceonHealthPromotionorganizedby theWHO in1986, theOttawaCharter7

waspresented. Health promotionbecame recognisedas theprocessofenablingpeople to increasecontrolover,and to improve, theirhealth.To reachastateof completephysical,mentalandsocialwellbeing (i.e.healthasdefinedby theWHO),an individualorgroupmustbeable toidentify and to realise aspirations, to satisfy needs, and to changeorcopewith theenvironment. Health is therefore, seenasa resource foreveryday life,andnot theobjectiveof living. Health isapositiveconceptemphasisingsocialandpersonal resources,aswellasphysicalcapacities.

2 Clearly,healthpromotionisnotonlytheresponsibilityofthehealthsector,butgoesbeyond to includeactionsdirectedatchangingsocial,environmentalandeconomicconditions,strengtheningskillsandcapabilitiesof individuals,aswellascausinghealthychoiceseasier tomake. The fivekeyactionareas foreffectivehealthpromotionare tobuildhealthypublicpolicy, tocreatesupportiveenvironments forhealth, tostrengthencommunityactionfor health, to developpersonal skills, and to re-orient health services.

3 In today’sglobalisedworld, increasing inequalitieswithinandbetweencountries and communities are seen,making vulnerable groups suchaswomen,children,elderly,disabled,poor,unemployed, immigrantsatparticularlyhighriskofunhealthylifestylepracticesandillhealth.Recognisingtheenjoymentof thehighestattainablestandardofhealthasafundamentalrightofhumanrace,itremainsforeverygovernment,community,civilsocietyandcorporate toplacehealthat thecentreof itsdevelopmentagenda. Inessence,eachsectorhasitsuniqueroletoplaytocontributetoimprovementsinpublichealth,andpartnershipswillprovideexcitingandrewardingwaystobringthemtogether. Buildingonthevalues,principlesandactionstrategiesof theOttawaCharter, theBangkokCharter8 in 2005 reaffirmed thatpoliciesandpartnerships toempowercommunitiesand to improvehealthandhealthequalityshouldbecentral toglobalandnationaldevelopment.

7OttawaCharter.WHO,19868TheBangkokCharterforHealthPromotioninaGlobalizedWorld.WHO,2006

70

Whenishealthpromotioneffective?

4 The ultimate goal of health promotion is to improve an individual’sphysiologicaland/orsocialaspectsofhealth. Forhealthpromotionactiontobeeffective,onemustdotherightthinganddoitwell.Thisunderscorestheneedtobuildcapacity in thehealthpromotionworkforce,be it in thepublic,privateornon-governmentalsector, inorder that limitedresourcescouldbeput tobestuse. Goodhealthpromotion followsaplanningandevaluationcycle9(seeFigure1).

Figure 1. Health promotion planning and evaluation cycle9

Theoryhelpsidentifywhataretargetsfor

intervention

Theoryhelpstoclarifyhowand

whenchangecanbeachievedintargetsforintervention

Theoryindicateshowtoachieve

organizationchange,andraisecommunity

awareness

Theoryprovidesabenchmarkagainstwhichactualcanbecomparedwithidealprogram

Theorydefinesoutcomesand

measurementsforuseinevaluation

Problem definition (redefinition)

1

Impact assessment

5

4

3

2Solution

generation Outcome assessment

Implementation

Resource mobilisation

7

Intermediate outcome

assessment

6

9TheoryinaNutshell,AGuidetoHealthPromotionTheory.NutbeamDandHarrisE,McGraw-Hill,2002(reprinted)

Annexes

71

5 Nutbeam10proposedaSixStageDevelopmentalModelforhealthpromotionresearch,planningandevaluation,pointingout thestrategic relationshipbetweencause, target population, content andmethodof intervention.That is tosay,everyproject inhealthpromotionmustbeginwithproblemdefinition (understandingwhat theproblem is,whyandhow it arose),followedbysolutiongeneration(how itmaybesolved), intervention testing(whether thesolutionworked), interventiondemonstration (how theactioncouldberepeatedandrefined),dissemination(if theactioncouldbewidelyreproduced)and finallyprogrammemonitoring (whether theprogrammecouldbesustained).Onceahealthpromotionprogrammehasreachedstagesix,emphasisshouldbeonsupportingprojectmanagementandassessingcostandbenefits for thesakeofmaximisingprogrammecost-effectiveness.

6 Intheeffort todemonstrateeffectivenessofahealthpromotion intervention,onemustdistinguishbetween thedifferent typesofoutcome inorder tocommunicatewhatconstitutessuccess.Threelevelsofoutcomeexist. Thefirst level comprises ‘healthpromotionoutcomes’ representing themoreimmediate resultofactions.Examplesarehealth literacy,social influence,publicpolicyandorganizationalpracticesthataffectan individual'sability tomakehealthychoices.Thenextlevelis‘intermediatehealthoutcomes’suchashealthy lifestyles,effectivehealthservicesandhealthyenvironmentsthatdetermine thehealthof individuals thereby impactingon thehighest levelof ‘healthoutcome’, typicallydescribedbymortality,morbidity,disability,qualityof life,andsoon. Implicit in this three-levelconstruct is thenotionthatchangesgeneratedinthedifferentlevelsofoutcomewilloccuraccordingtodifferent timescales,dependingon the interventionandtypeofproblembeingaddressed.Forthisreason,itisnotunusualtotakeadecadetoprovecertain interventionsareeffectiveat thehealthoutcomelevel,andeventhismaybedifficultgiventhepresenceofconfoundingfactorsduringtheinterim.

10NutbeamD.EvaluatingHealthPromotion:Progress,ProblemsandSolutions.HealthPromotionInternational1998;13(1):27-44.

72

7 Forahealthpromotionprogrammetosucceed,theremust,firstandforemost,beaneffective intervention. Formativeevaluationwillexaminehowwell theinterventionhasachievedtheplannedchangesorsetobjectives.Then,everyaspectoftheinterventionmustbecarriedoutproperlytoachievetheexpectedresults. Processevaluationwillprovidethe informationthat theprogrammehasindeedbeenimplementedasplanned.Forsomeprogrammes,outcomeevaluationmay not be required so long as the programmehas beenconductedasplanned,andtheexpectedresultswill follow. Forexample, itwillnotbenecessary toevaluatesuccessofa tobaccocontrolprogrammesinceinevitablyfewerpeoplewilldiefromlungcancerifthereisareductioninsmokinguptakeandprevalence.Forotherprogrammes,impactevaluationtoexamineknowledge,skill,attitudinal,behavioural,serviceuse,environmentalorpolicychangeswillberequired.

Findinganinterventionthatfits

8 Experienceshowsthatprogrammesaremore likely tobesuccessfulwhenthedeterminantsofthehealthproblemarewellunderstood,wheretheneedsandmotivationsof the targetpopulationareaddressed,and thecontext inwhichtheprogrammeisimplementedhasbeentakenintoaccount.Theuseoftheories11 thatexplainandpredicthealthbehaviourandbehaviourchangecanhelp in theunderstandingof thenatureof theproblem, theneedsandmotivationsof thetargetpopulationandthecontext, thuspromotingabetterfitbetweenproblemandprogramme.Healthpromotiontheoriesarebroadlycategorisedaccording to the levelof intervention– individual, interpersonalandcommunitylevel.

11TheoryataGlance,AGuideforHealthPromotionPractice(secondedition).NationalCancerInstituteUSDHHS,2005

Annexes

73

9 Notableexamplesof theories thatexplainbehaviouralchange in individualsinclude the Health BeliefModel (HBM) and the Stages of Change(Transtheoretical)Model. TheHBMaddressesan individual’sperceptionsofthethreat(suchassusceptibilityandseverity)posedbyahealthproblem,thebenefitsofavoidingthethreatandfactors influencingthedecisiontoact(barriers,cuestoactandself-efficacy).Sincehealthmotivationisthecentralfocus, theHBMisagoodfit foraddressingproblembehaviours thatevokehealthconcerns,e.g.HIV infection. TheStagesofChangeModel,on theotherhand,arguesthatbehaviourchangeisaprocessratherthananevent.Peoplegothroughfivestagesofbehaviouralchangefrompre-contemplation,contemplation,preparation,actiontomaintenance.Thoseatdifferentstagesofchangehavedifferent informationalneedsandbenefit frominterventionsdesignedspecifically for thatstage. Themodel iscircularsincepeopledonotsystematicallyprogressfromonestagetothenext,butenterthechangeprocessatanystage, relapse toanearlierstage,andbegin theprocessagain,untilthemodelstopsatsomepoint.Atypicalexampleisquitsmokingbehaviour.

10 Theoriesat the interpersonal levelassume individualsexistwithin,andareinfluencedby,thesocialenvironmentconsistingoffamily,friends,coworkers,professionals,andsoon. SocialCognitiveTheory (SCT) isa frequentlyusedtheory.SCTdescribestheongoingdynamicprocessinwhichpersonalfactors,environmental factorsandhumanbehaviourexert influenceononeanother. If individualshaveasenseofself-efficacy, theycanchangebehavioursevenwhenfacedwithobstacles.Iftheylackthesenseofcontrol,theyarenotmotivatedtoactandcannotpersistthroughchallenge.SCThasbeenusedsuccessfullyinareasrangingfromdietarychangetopaincontrol.

11 Community levelmodelsexplorehowsocialsystems functionandhow tomobilisecommunitymembersandorganizations. Theyofferstrategies thatwork inavarietyofsettingssuchasschools,worksites,communitygroups,andsoon.Awell-knownexampleistheDiffusionofInnovationsTheorywhichstates thatpublichealthpractitionersmustattend to the reach,adoption,implementationandmaintenanceofprogrammestooptimisetheirefficiency.Forexample,cancercontrolprogrammeswillnotrealisetheirfullpotentialforimprovingpopulationhealthuntiltheyarebroadlydiffusedanddisseminated.Diffusionof innovationsthatpreventdiseaseandpromotehealthrequiresamultilevelchangeprocesstakingplace indiversesettings. This theoryhasbeenused in thepromotionofcondomuse,smokingcessationanduseofnewtestsandtechnologiesbyhealthprofessionals.

74

12 Inpractice,nosingletheorydominateshealtheducationandhealthpromotion,norshould it. Adequatelyaddressingan issuemayrequiremore thanonetheory,andnoonetheoryissuitableforallcases.

Healtheducationisnothealthpromotion

13 A distinction needs to bemadebetweenhealth education and healthpromotion.Healtheducation,according to theGlossaryofPublicHealthTechnicalTerms12, represents consciously constructedopportunities forlearning, for individuals,groups,organizationsandcommunitieswhicharedesigned to facilitatechanges inbehaviour towardsapre-determinedgoalandsoas to improvehealthstatus. Commonmodalities includemediapublicity,pamphletdistribution,posterexhibitionsandhealth talks. Healtheducationhasalonghistoryindiseasepreventioncharacterisedbyemphasisontransmissionof information,baseduponasimplisticunderstandingof therelationshipbetweencommunicationandbehaviourchange. It isclear thatinformationtransmissionalonecannotachieveimpactsonbehaviourchangeas itdoesnot take intoaccountsocialandeconomiccircumstancesof thetargetgroup.Onlytheeducatedandeconomicallyadvantagedbenefitastheypossesspersonalskillsandeconomicmeanstoreceiveandrespondtohealthmessagescommunicatedthroughconventionalmeans.Despitestrengtheningofhealtheducationby thedevelopmentanduseofbehavioural theories intheeighties,health interventions relyingoncommunicationof informationhavemostly failedtoachievesubstantialandsustainableresults in termsofbehaviouralchange,andhavemadelittleimpactintermsofclosingthegapinhealthstatusbetweensocialandeconomicgroupsinsociety.Tobeeffectiveinimprovinghealth,morepersonalformsofcommunication,andcommunity-basededucationaloutreach,focusedonbetterequippingpeopletoovercomestructuralbarrierstohealthareneeded.

12GlossaryofPublicHealthTechnicalTerms.EuropeanCommission,1996

Annexes

75

Effectivehealthpromotioninaction

14 Oneof themostsuccessfulhealthpromotionstoriescanbefound inNorthKarelia. Kareliaused tobea lowsocio-economicarea in theeasternpartofFinlandinthe1970swhichreliedondairyfarmingasthemajorsourceoflivelihood. Peoplesmokedheavilyandconsumedahigh-fatdietwith lowfruitandvegetable intake. Finlandhadtheworld'shighestdeathrate fromcardiovasculardiseasesasaresultofwidespreadandheavysmoking,highfatdiet(e.g.heavyconsumptionofdairyproducts)andlowvegetableintake.NorthKareliahadaheart-diseaseratetwicethatofFinlandasawholeatthattime.

15 TheNorthKareliaProjectwas launchedwithassistance from localandinternationalexperts. Itwasa large-scalecommunity-based intervention,involvingNGOs,consumers,schools, food industry,supermarkets,massmedia,agricultureandsocialandhealthservices. It included legislationbanningtobaccoadvertising, the introductionof low-fatdairyandvegetableoilproducts,changesinfarmers’paymentschemes(linkingpaymentformilktoproteinrather thanfatcontent),and incentivesforcommunitiesachievingthegreatestcholesterol reduction. Doctorsandnurseswereaskedtohelpmodify risk factorsof theirpatientsandclients. Opinion leaders invariousvillageshavebecomeprojectassistantsandmanyhealthpromotionactivitiestookplaceatworkplaces. Peopleunderstood theirhealth riskand tookresponsibilityfortheirownhealth,whetherbywatchingtheirdietorexercising.

16 Theprojectcausedsignificant reductions inrisk factorsandcardiovasculardiseasemortalityby73%. Success factors includeda focusonrisk factorreduction,multisectoralcollaboration,population-basedapproach,communitysupportandstronggovernmentcommitment.

Partofthephotographsonthecoverwasprovidedthroughthecourtesyof

EducationBureauLeisureandCulturalServicesDepartmentKowloonTongSchool(PrimarySection)

St.Paul’sCollegePrimarySchoolMrJustinLAWKai-chun

MsLAUKa-yeeMrCliffLUI

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